September-December
2008 Archives:
December 2, 2008 -- 8:20pm EST
Volcano Corporation: Intravascular Imaging
Ascending
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Over two decades ago, I sat in
an office at UCSF with Dr. Paul Yock, discussing his latest invention:
intravascular ultrasound (a.k.a IVUS). I was working with him
and his partner, Dr. Peter Fitzgerald, on a training video, teaching
cardiologists how to interpret the images of this new and unheard
of technology. |
It was the mid-80's, and I, optimist that I was/am,
was certain that this new way of visualizing the interior of the
coronary artery would lead to a breakthrough in treatment. My opinion
was validated -- it just took a couple of decades....
The product, at that time manufactured and marketed
by a company named CVIS, was ultimately acquired by Boston Scientific.
A competing IVUS technology was developed by Endosonics, which was
purchased by Jomed, and which ultimately was acquired by Volcano
Corporation. So, today in 2008, we have a duopoly in the IVUS field:
Volcano and Boston Scientific.
But, while Boston Scientific has a wide-ranging
array of medical devices, from stents to ICDs, Volcano has concentrated
solely on the development and implementation of intravascular technologies,
such as IVUS, Fractional Flow Reserve (FFR), OCT, VH-IVUS and forward-looking
IVUS. And to Volcano's credit, the two currently-approved areas,
IVUS and FFR, are proving to be not just helpful adjuncts to percutaneous
interventions, but critical tools to improving outcomes. And subsequently,
profit centers for the company.
A quick look at this recent history of stock prices
tells part of the story. Compared to its price six months ago, Volcano
actually has increased its value by 19% -- this, in the
midst of the worst economic meltdown since the Depression. Meanwhile,
the four major stent manufacturers have suffered significant downturns,
the worst being Volcano's chief competitor, Boston Scientific.
There are a number of reasons why Volcano has been
performing so well -- many of them business decisions that we will
not get into here. But the interesting facts for patients are that
a technology that allows cardiologists to see and measure inside
of the artery (IVUS) provides for more accurate stent placement and
expansion, and theoretically lower rates of stent thrombosis.
And being able to measure the specific blood pressure
passing through a suspected arterial blockage (FFR) provides data
for an informed treatment decision: is this blockage causing ischemia
or not? (The recent FAME study showed quite dramatically that using
FFR significantly improved patient outcomes by eliminating unnecessary
stent placement.)
Professional interest in these technologies is
at an all-time high -- at the recent TCT meeting in Washington, Volcano's
evening symposium on IVUS and related technologies attracted the
largest number of registrants of any evening meeting.
The whole field of intravascular imaging is an
exciting one. Current technologies can help target therapies for
the greatest benefit. Future technologies may marry treatment with
observation, opening up a new era of interventional cardiology.
November 30, 2008 -- 6:30pm EST
Popular Press Continues to Breed Confusion
Over CT Heart Scans
I
scanned (pun intended) the current health news today and came up
with the following assortment of reports about a study that was
published, along with an accompanying commentary, in this week's New
England Journal of Medicine:
Confused? Of course you are. And the correct headline
depends on your point-of-view...and your agenda: a perfect example
of the Rashôman effect.
The study in question reports the results of an
international multicenter trial (CorE 64) conducted by the team of
imaging specialists at Johns Hopkins, and is titled "Diagnostic
Performance of Coronary Angiography by 64-Row CT". The data
originally were presented a year ago at the American Heart Association
annual meeting (Angioplasty.Org covered that presentation in our
article, "64-Slice
CT Heart Scan Gets High Marks As Test for Blocked Arteries")
and the data showed that CT angiography had very high predictive
value for diagnosing coronary artery disease. The CorE 64 study was
partly funded by Toshiba Medical Systems, a manufacturer of CT scanners.
The accompanying and critical commentary, published
by the NEJM as a "Perspective" piece, is titled, "Pay
Now, Benefits May Follow — The Case of Cardiac Computed Tomographic
Angiography" and is co-authored by Dr. Rita Redberg of UCSF.
In this op-ed piece, Dr. Redberg continues her critique of CT angiography
as being an unproven and unnecessary test -- a view that she last
voiced via a June
New York Times article. Dr. Redberg's disclosures show that her
work is supported by the insurer, Blue Shield of California Foundation.
So, on the surface, it seems to be a conflict between
the imaging industry and the medical insurers. But I find that, in
the case of CT angiography, this adversarial relationship is a straw
man. For example, the accuracy of CT angiography could potentially
eliminate many invasive angiograms, one third of which are negative,
thus significantly reducing costs and complications for patients.
Also, the Reuters article states categorically
that "the amount of radiation received with a CT heart scan
is double, triple or quadruple the exposure in conventional angiography." Perhaps
that was true years ago. But today the typical CT scan is the same
as or less than conventional angiography. Not so for the very often
used nuclear stress test -- which in fact does expose the patient
to double or triple the radiation.
This is a complex subject and I will be dealing
with it in more detail on Angioplasty.Org. Check the news
page later this week.
September 24, 2008 -- 10:30pm EDT
CBS Goes Radial
This morning's "Early Show" on
CBS featured a "Heart Watch" segment with Dr. Howard
Cohen of Lenox
Hill Hospital in New York about "The New Angioplasty" --
namely angioplasty performed from the wrist, or transradial approach.
It's not exactly "new", having first been done in the
early 90's, but it's somewhat new to the U.S. (Read more about
it in today's feature: "Is
Radial Angioplasty at a Turning Point in U.S.?")
Here's the clip (there IS a commercial at the start
and finish -- hey, even CBS has to pay the rent....):
Courtesy CBS News
For more information, you can read Angioplasty.Org's exclusive
interview with Howard Cohen and his partner Kirk Garrett in
our Radial Access
Center. CBS did.
Late Update: CBS has also posted a
followup article on its website. Good to see MSM exposure for
this under-utilized technique.
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