The coronary angiogram is often referred to as a road map of the heart. As such, it serves the cardiologist and cardiac surgeon well. It shows where the coronary arteries are, how they intersect, the angles of the branches, etc. There are diagrams of these anatomical features in many textbooks, but the reality is that these characteristics can vary from individual to individual, so it’s necessary to get a road map for each individual in whom an intervention is being contemplated. Then, of course, there’s the issue of narrowings in the coronary arteries. Should these receive stents? Should they be bypassed? Should they be left alone and treated with medical therapy? Continue reading
Category Archives: FFR
Former President George W. Bush received an angioplasty and stent this morning at Texas Health Presbyterian Hospital Dallas. The stent was recommended by Bush’s doctors to open a blockage in one of his coronary arteries, found yesterday during what was described by Bush spokesman Freddy Ford as his annual physical exam at the Cooper Clinic in Dallas. Continue reading
I added a new category “tag” to the stent blog today: “Back to the Future.” And I hereby declare this to be an internet meme, even if it’s only a meme on this site!
I added this category because every TCT or ACC or AHA or ISET or ESC or EuroPCR meeting that I cover, I am struck by the fact that the newest, latest, greatest innovations are all ideas that were present at the genesis of this field of interventional cardiology. Continue reading
Partnering with informed patients is a central tenant of the newly released joint 2012 Guidelines For Diagnosis and Management of Patients with Stable Ischemic Disease, as well as SCAI’s consensus update on Ad-Hoc PCI. And new studies about angioplasty and stents are being presented regularly that call for shared decision-making: for example, the OVER study, showing that endovascular repair of abdominal aortic aneurysms with stent grafts is equivalent to open surgery, the FREEDOM study discussing the options for multivessel disease in diabetic patients, and FAME 2 for the treatment of stable heart disease with significant ischemia as measured by fractional flow reserve. Patient preference comes into play in all of these. Continue reading
Something that is “on the table” is defined as an item that is “up for discussion.” And this week The Society for Cardiac Angiography and Interventions (SCAI) issued a consensus statement about the proper use of “ad hoc PCI” — and the patient was definitely on the table, up for discussion, part of the conversation.
Since we’re into definitions, ad hoc PCI is the scenario in which a diagnostic catheterization is followed in the same session by PCI (angioplasty and stents). And this is a common scenario: in New York State, for example, 80% of all angioplasties are done in the same session as the diagnostic angiogram, although the vast majority of these are emergency or primary angioplasties, where a patient in the midst of a heart attack (or close to it) is brought into the cath lab and the blockage is opened up, saving the heart muscle and possibly the patient’s life. Continue reading
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