Category Archives: IVUS

Post-Dilatation Stent Sizes

2018 stent expansion chart

click for hi-res PDF of chart

For the interventionalist, proper sizing of coronary stents is critical. While imaging via angiography has been the standard for years, newer intravascular imaging technologies, such as IVUS and OCT, are becoming more widely used, as evidence accrues that these modalities make a difference in outcomes. For example, IVUS (Intravascular Ultrasound) not only allows the measurement of the exact open diameter of the vessel, as seen on angiography, but it shows the “invisible to angiography” layer of plaque. plaque that will be compressed, so that a more accurate post-PCI diameter can be determined. Under-expanded stents have been associated with increased stent thrombosis and restenosis. Continue reading

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Filed under Angiograms, Drug-Eluting Stents, Imaging, IVUS, OCT, Stent, Stent Thrombosis

COURAGE: Does 15-Year Data Have Any Clinical Relevance?

pills_vs_stent_140sqThis past week saw publication of an update to the 2007 COURAGE trial which compared optimal medical therapy (OMT) to stenting (PCI) as the initial management strategy for stable coronary artery disease. (Please note the phrase “initial management strategy.” This will not be the last time you see it in this post.)

Appearing in the New England Journal of Medicine and titled “Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease,” this study, performed by Dr. Steven P. Sedlis and other COURAGE trial investigators, is described as “an extended survival analysis to examine the potential long-term survival benefit from initial PCI among the patients with stable ischemic heart disease who were followed for up to 15 years after initial enrollment in the COURAGE trial.”

This new analysis concluded: “…we did not find a difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone in patients with stable ischemic heart disease.” This also was the finding of the original COURAGE trial at five years. Continue reading


Filed under Appropriate Use Criteria (AUC), Bare Metal Stents, Clinical Trials / Studies, COURAGE, Drug-Eluting Stents, FAME I / FAME II, FFR, Intravascular Guidance, IVUS, OCT, Optimal Medical Therapy, Stent

Philips Buys Volcano: It’s About Money, Technology, and History

  Rumors and theories about an acquisition of Volcano Corporation (NASDAQ: VOLC) had been circulating for quite some time: months, years even. The company seemed an obvious choice: it has an advanced intravascular ultrasound (IVUS) technology that leads the market, with Boston Scientific coming in second; it has a fractional flow reserve (FFR) wire that splits the market with St. Jude Medical; and recently Volcano gained FDA approval for its Instant Wave-Free Ratio (iFR) physiologic measurement product, a faster, cheaper potential alternative to FFR. Continue reading

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Filed under ACC, Angiograms, Back to the Future, Business & Industry, Cardiac CT, Cost Effectiveness, FFR, Global Trends, History, Imaging, Intravascular Guidance, IVUS, OCT, Video

Can Using IVUS (Intravascular Ultrasound) Prevent Stent Thrombosis?

IVUS image shows stent under-expansion (click for larger image)

IVUS image shows stent under-expansion (click for larger image)

A recent paper, published online before print in SCAI’s journal, Catheterization and Cardiovascular Interventions, yet again adds to the evidence that intravascular ultrasound (IVUS) imaging during PCI can improve stent placement and expansion in a way that may prevent stent thrombosis (ST).

Titled, “Angiographically confirmed stent thrombosis in contemporary practice: insights from intravascular ultrasound“, the study looked at five years (2005-2010) of a multicenter registry of stent thromboses and studied the IVUS images where performed. Continue reading

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Filed under Innovators, IVUS, Japan, Stent Thrombosis

Stent-Trek: The Next Generation

Starship Stenterprise

Starship Stenterprise

Yeah. I went there. Since everyone from Motley Fool to MassDevice to the Wall Street Journal feels the need to use “Stent Wars” (a pun that I originated on this website a decade ago) I’ve decided to go all TV. Actually, “The Next Generation” is also a more appropriate reference than the “Wars” moniker, because the story here is no longer so much about behemoth entities and dark lords battling each other for control of the universe (not that this aspect has gone away) but a story of refinement, sleeker technology and, yes, much more Data! And this past couple of weeks has seen some important developments in the next generation of stents that are positive for both patients and physicians. Continue reading

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Filed under Antiplatelet Medications, Clinical Trials / Studies, FFR, High Blood Pressure, Innovators, Intravascular Guidance, IVUS, Meetings & Conferences, OCT

Women’s Heart Disease and Intravascular Ultrasound (IVUS)

Dr. Habib Samady of Emory in Atlanta at IVUS console

Dr. Habib Samady of Emory in Atlanta at IVUS console

I’ve written before about the use of IVUS in stent and angioplasty procedures in women, most recently in October about a study done at NYU Medical Center. My article, “Intravascular Ultrasound (IVUS) Imaging Reveals Hidden Heart Attack Culprit In Women“, showed how intravascular imaging could detect a type of coronary disease not seen on angiography.

Now a similar tale has been broadcast by CBS affiliate WGCL-TV in Atlanta about how a type of coronary narrowing more typical in women may not be seen on a standard angiogram because it’s evenly distributed along the arterial wall or channel and doesn’t appear as a “spike” or sudden narrowing — yet it may be restricting the flow of blood to the heart just the same. Once again — angiography alone is not enough to accurately diagnose coronary artery disease and guide its treatment. Continue reading

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Filed under IVUS, Media Coverage