Category Archives: Stent

Boston Scientific’s New Drug-Eluting Stent in the News Again

Boston Scientific's Element Stent vs. Medtronic's Integrity

Which stent platform do you think compresses more easily: Boston Scientific’s Element (top) or Medtronic’s Integrity (bottom)?

I first heard concerns about stent deformation, primarily seen in the PROMUS Element stent made by Boston Scientific (NYSE: BSX), during a presentation at a small interventional meeting last summer. The issue was then reported in two journal articles, just prior to the TCT meeting in November, where it became a topic of much attention — although most interventional cardiologists felt that it was nothing like the problem of late stent thrombosis, first seen as a “rare” event in the first generation of drug-eluting stents five years ago. Continue reading

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Filed under FDA, Stent

A Stent By Any Other Name

Stent and RoseForgive the perverse Shakespearean pun in the title but, as the Bard wrote: “What’s in a name? That which we call a rose by any other name would smell as sweet.” My topic is pretty much the polar opposite of roses, but the whole concept of labels and what we call things has become increasingly important. It’s one that I touched on in my post over last weekend about the impending CMS audits of stent procedures: namely, that the “official” terms used to describe treatment of a blocked artery are flawed when it comes to proper use of the English language.

The official “Appropriate Use Guidelines” place stent and angioplasty procedures into three categories: Appropriate, Uncertain and Inappropriate. Any patient, potential patient or, for that matter, anyone not steeped in the minutiae of interventional cardiology, would look at those terms and assume that any doctor putting a metal coil into someone’s heart when the procedure was labeled “uncertain” or “inappropriate” should be fined or fired or both. Continue reading

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Filed under Appropriate Use Criteria (AUC), COURAGE, Media Coverage, Stent

Stent as Concertina

A "Stent Concertina"Call it an accordian, a concertina or a “squeezebox”…but don’t call it a stent. Because one thing that is not music to your ears is a coronary stent that you have carefully placed to relieve your patient’s symptoms — and which then gets shorter or longer when you push or pull another catheter, balloon or wire through it.

This is an issue that was first raised a little over a month ago and it has been the subject of a number of news articles. It’s been dubbed “the concertina effect” but its scientific name is “longitudinal stent compression” or “longitudinal stent distortion” and it’s of concern because once a stent has been correctly sized and placed in just the right position to keep a blockage open…well, you don’t want it moving or changing shape. Continue reading

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Heart Attack Stopped with a Stent

AmbulanceI’m working on at least six different articles about the many studies presented at the American College of Cardiology in New Orleans yesterday and today, from new stents to transradial vs. femoral access, etc. etc. etc. and suddenly all of this is swept aside by an email that arrived in my Inbox seconds ago, posting the following to the topic of Heart Attack and Stents or Angioplasty on our Patients Forum:

 

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Filed under Heart Attack, Patients, Stent

Laser Wars: Volcano Vindicated on OCT Trade Secret Suit

OCT Laser WarsLast week the Superior Court of Massachusetts entered a Final Judgment in the latest round of “Laser Wars” being waged between Volcano Corporation (NASDAQ: VOLC) and St. Jude Medical (NYSE: STJ). Both companies “lasered up” a few years ago…and that has led to their “lawyering up” — remember “Stent Wars“?

In fact, Dr. Julio Palmaz, co-inventor of the first angioplasty balloon exandable Palmaz-Schatz stent, told me last year that the biggest thing an inventor needed to understand was just how much time he’ll be spending in court, defending his patent. That certainly is the case with the laser technology used in a new generation of intravascular imaging catheters, called OCT (Optical Coherence Tomography) which can be used to image the inside of a coronary artery, look at a stent’s positioning, whether it has healed correctly, etc. Continue reading

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Filed under Intravascular Guidance, OCT, Stent

Angioplasty and Stent Use Cut in Half — Sort of…

Scissors and StentA lost story this past couple of weeks has been an “admission” by the American Heart Association that the number of angioplasties performed in the United States is actually half of what the AHA has been saying all these years.

In their most recent 193-page Heart Disease and Stroke Statistics 2011 Update, published on December 15, the AHA now states that 622,000 percutaneous coronary interventions (PCI) were performed in 2007 (the most recent period for which stats have been compiled). Previously the AHA reported an annual volume of around 1.3 million — double the number. Continue reading

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Filed under COURAGE, Media Coverage, Stent

Stent Accusations: The U.S. Senate Tries to Drum Up COURAGE

Stent and the SenateMonday’s 172-page Senate Finance Committee Staff Report on the overuse of coronary stents by Dr. Mark Midei at St. Joseph’s Hospital in Maryland has been all over the news — over 300 articles to date, claiming fraud, malpractice, pig roasts, threats to reporters — all of which serve to rekindle the “anti-stent” sentiment that followed on the heels of the COURAGE study back in 2007. In fact, Dr. William Boden, principal investigator for COURAGE, was interviewed for the Senate report, which characterized him as follows: Continue reading

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Filed under Angiograms, COURAGE, Drug-Eluting Stents, FFR, Interviews, Media Coverage