Category Archives: OCT

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

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

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

OCT Wars: St. Jude Versus the Volcano

Axsun laser module and OCT imageOptical Coherence Tomography (OCT) is an exciting new imaging technique that is being used to assess the interior anatomy of coronary arteries during and after angioplasty and stent placement. (Read our exclusive interview with Dr. Giulio Guagliumi for more information about how OCT can aid in measuring the healing of stents.)

This technology is just now beginning to bridge the divide between research tool and clinical aide — for example, OCT can show high resolution pictures of stent struts and show whether they are covered or not. So the future for OCT imaging is definitely of major interest. Continue reading

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Filed under Intravascular Guidance, Media Coverage, OCT