September 18, 2012 · 8:42 pm

An Informed Patient is a Healthier Patient

Doctor and patientFindings in a report issued last week by the Blue Shield of California Foundation demonstrate that an informed patient is an empowered patient: one who feels more comfortable asking questions of one’s healthcare provider, and making decisions about one’s own healthcare.

While this equation may seem obvious, the report puts numbers to the equation, marking the significant differences between the informed and uninformed patient. Most importantly, the patient population studied consisted of low income families with annual household incomes less than 200% of the federal poverty level, or about $46,000 for a family of four. Continue reading →

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Filed under History, Patient Empowerment, Patient Experience, Patients, Shared Decision-Making

September 16, 2012 · 7:11 pm

35th Anniversary of Coronary Angioplasty

Angioplasty balloon being manufactured on the kitchen table in Gruentzig’s apartment

Today is the 35th anniversary of the first percutaneous transluminal coronary angioplasty (PTCA) which was performed in 1977 by Dr. Andreas R. Gruentzig in Zurich, Switzerland. This angioplasty procedure utilized an expandable balloon, fashioned on a kitchen table in Gruentzig’s apartment by Gruentzig’s assistant, Maria Schlumpf (note the bottle of wine…and yes, she used Krazy Glue).

The patient was Adolph Bachman, age 37 (the same age as Gruentzig), who was scheduled for bypass surgery. Gruentzig has been working on this idea for several years; it was an idea first germinated by a U.S. radiologist, Dr. Charles Dotter, in the early 60’s. Dotter in fact coined the term “angioplasty” to describe opening up a blocked artery not through open surgery, but by threading a catheter into the artery and opening it up from the inside out: less traumatic, quicker, and possibly (he thought) more durable.

Dotter’s idea was mocked as crazy (he became known as “Crazy Charlie”) by the surgical community of the day and it took years for Dotter’s concept to travel across the world to Europe, where Gruentzig learned about it. He added a balloon to the tip of the catheter and, after experimenting in the lab in Zurich, he teamed up with Dr. Richard K. Myler of San Francisco to try the idea intraoperatively in patients who were having open heart surgery.

When the concept had been proven in a few of these surgical cases, Gruentzig returned to Zurich to attempt doing an angioplasty in the cath lab without surgery: percutaneously — just through a needle stick, the same procedure as a diagnostic angiogram. Except with a balloon. That’s where our video below begins: the story of the first angioplasty.

(By the way, the clip below is excerpted from my feature-length award-winning documentary, “PTCA: A History,” which tells the whole tale of how this “crazy” idea turned into a major branch of modern medicine. The complete 72 minute DVD is available for sale on our web site — of course!)

Continue reading →

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Filed under History, Innovators, Video

September 15, 2012 · 9:45 pm

Jerry “The King” Lawler Has Heart Attack (on the air) and Stents (not on the air)

Jerry Lawler

Jerry Lawler, announcing during a match in 2007 (courtesy Mshake3)

Jerry “The King’ Lawler, semi-retired professional wrestler, holder of 168 championships (reportedly) and commentator for WWE’s “Monday Night Raw” collapsed on September 10, during a live broadcast in Montreal, Canada.

62-year-old Lawler was having a heart attack.

EMTs performed CPR and defibrillated him (seven times, it is reported). He was revived and rushed to a Montreal hospital where he received an angioplasty with two stents. Continue reading →

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Filed under Celebrity Patients, Heart Attack, Stent, Video

· 7:46 pm

Patient Alert: Don’t Take NSAIDs After a Heart Attack

NSAID tabletsA study from Denmark of almost 100,000 patients over a 12-year period has concluded that:

The use of NSAIDs is associated with persistently increased coronary risk regardless of time elapsed after first-time MI. We advise long-term caution in using NSAIDs for patients after MI.

The study, published online before print in Circulation is titled, “Long-Term Cardiovascular Risk of NSAID Use According to Time Passed After First-Time Myocardial Infarction: A Nationwide Cohort Study.”  The researchers looked at the nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark for the years 1997-2009 and calculated the incidence of death and heart attack associated with NSAID (Non-Steroidal Anti-Inflammatory Drug) use up to five years after a heart attack (in one-year increments). Continue reading →

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Filed under Heart Attack, Patient Alert, Patient Empowerment, Patients, Risk Factors

· 1:00 pm

Results of the ADVISE Registry Published

Artist rendition illustrating the iFR "Wave Free Period"

Artist illustration of the iFR “Wave Free Period”

As previously reported on Angioplasty.Org, a new method for the functional measurement of intracoronary pressures and the severity of blockages has been developed by researchers at Imperial College in London. One of the main advantages of this new method, called Instant Wave-Free Ratio™ (iFR), is that, unlike standard fractional flow reserve (FFR), it does not require injection of a vasodilator drug, such as adenosine, to induce stress on the heart. The result is that the procedure is more comfortable for the patient and potentially useable in clinical scenarios where vasodilation is not feasible, such as acute coronary syndromes, infarctions, unstable patients, patients with breathing problems; it may also be somewhat quicker, easier to use, and more cost-effective. Continue reading →

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Filed under Appropriate Use Criteria (AUC), Cost Effectiveness, FAME I / FAME II, FFR, Interviews, Intravascular Guidance, Stent

September 14, 2012 · 9:00 pm

The Stent Blog Has a New Look

Burt at his laptop Hard to believe it, but I started this blog eight years ago! Ouch!

So it’s certainly ripe (more like over-ripe) for a bit of a change — you know, we need to re-invent things at least once a decade…. So here it is. We’ve designed a new look but, more importantly, we now will be able to link more easily to a variety of social networking tools, show off our Twitter feed and post appropriate comments from our readers.

And, even more importantly, our posts will have category tags so you’ll be able to find all my scintillating insights into the various controversies of the day, such as Appropriate Use Criteria or Fractional Flow Reserve or the Transradial Approach.

As with all change, this transition is a work in progress…or, in this case, regress. Which is to say, posts prior to March 2012 are still in the old school format, and can be accessed in our archives. But, as time goes on, we will be importing and tagging our older posts, all the way back to October 2004, into this new format.

Hope you all approve. Your comments are, of course, welcome.

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Filed under Social Networking, Web Site

August 14, 2012 · 12:10 pm

Happy 20th Anniversary to TransRadial Intervention (TRI)

Dr. Ferdinand Kiemeneij

Dr. Ferdinand Kiemeneij

I’ve written about this before, when Dr. Ferdinand Kiemeneij let me know back in April that this year was the 20th anniversary of the first angioplasty and stent placement performed via the radial artery in the wrist.

The procedure was done by Dr. Kiemeneij in The Netherlands — and it was exactly twenty years ago today when Dr. Kiemeneij taught the band to play!

And play it has. Many countries in the world now do the majority of interventional procedures via the wrist artery — and, alas, the United States is far behind the curve. Less than 10% of procedures are done this way here — but that too is changing. Continue reading →

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Filed under Health 2.0, Innovators, Transradial Approach