November 16, 2014 · 2:33 pm

Plavix and Aspirin After Stent: 8 Years Later – Is Longer Better?

plavix_and_stentNo one thought it would take quite so long to get this information, but in just a couple hours results from the Dual Antiplatelet Therapy (DAPT) Study will be presented at the American Heart Association Scientific Sessions 2014. The question to be answered: Is there a benefit to extending dual antiplatelet therapy (aspirin plus a thienopyridine, such as clopidogrel/Plavix, prasugrel/Effient, etc.) beyond one year after stenting?

This is a question asked back in 2006, during a special two-day FDA hearing, convened to discuss all known issues with drug-eluting stents and prompted by the “ESC firestorm” over the problems of increased incidence of late stent thrombosis in drug-eluting stents. (See “Problems Resurface with Drug-Eluting Stents” – September 9, 2006.) Continue reading →

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Filed under Antiplatelet Medications, Bare Metal Stents, Clinical Trials / Studies, Drug-Eluting Stents, Global Trends, Meetings & Conferences, Optimal Medical Therapy, Stent Thrombosis

November 11, 2014 · 2:13 pm

Vascular Surgery and the Battlefield: Honoring Our Veterans

Today is Veterans Day in the U.S., honoring the soldiers who fought in the country’s wars. Last week was the VIVA 14 meeting, presenting the latest advances and techniques in endovascular repair and therapy of blood vessels.

These two events are actually closely aligned: the development and advances made in vascular surgery, and now endovascular therapies, were pioneered on the battlefield. Continue reading →

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Filed under History, Innovators, Meetings & Conferences, Peripheral Artery Disease (PAD), Video

November 6, 2014 · 4:42 pm

Fractional Flow Reserve: Measuring Pressures in the Marketplace

Dr. Andreas Gruentzig

“I don’t know how anyone can do these procedures without measuring pressures!”

That’s what Andreas Gruentzig, the father of coronary angioplasty, said to me back in 1985. He knew that looking at the angiogram alone was not sufficient for judging the blockage in an artery. Integral to the design of his technological breakthrough, the double-lumen angioplasty balloon, was a feature which allowed him to measure the blood pressure at either end of the arterial blockage. At the start of the procedure, he could quantify how significant the blockage was; when he was done inflating the balloon, he could see the benefit of the dilatation. The post-angiogram might look good, but the pressures sometimes signaled that blood flow through the area was not. So, inflate again. And maybe again. OK, pressure now looks good, we’re done! Pretty simple. Not brain surgery. Continue reading →

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Filed under Business & Industry, Cost Effectiveness, FAME I / FAME II, FFR, History, Stent

November 5, 2014 · 2:30 pm

Crazy Charlie’s Amazing Idea: Angioplasty at 50

Dr. Charles Dotter in LIFE Magazine (1964)

Crazy Charlie. An August 1964 LIFE magazine photo spread on Dr. Charles Dotter reinforced that nickname, given to Dotter by the vascular surgeons who knew him and his work at Oregon Health Sciences University in Portland — and who did not like what he was doing. Unblocking arteries in the leg without surgery? From the inside, using catheters? Crazy!

So that was 50 years ago, and to call Dotter a visionary is a vast understatement because this week, radiologists, cardiologists and surgeons have gathered in Las Vegas, not to gamble (although who’s to say…) but to present and hear the latest information, late-breaking trials and reports on vascular interventional therapies at the VIVA 14 meeting and see demonstrations of an array of devices and techniques. Continue reading →

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Filed under Back to the Future, History, Innovators, Meetings & Conferences, Peripheral Artery Disease (PAD), Video

November 3, 2014 · 7:17 pm

The First Endovascular Abdominal Aortic Aneurysm Repair (EVAR)

November 4 begins the 14th Annual VIVA meeting in Las Vegas. Yes, that’s “Viva, Las Vegas!”

The whole field of endovascular repair and intervention has grown exponentially since the first VIVA meetings. For example, the first endovascular repair of an abdominal aortic aneurysm was performed by Dr. Juan Parodi in 1990, but it took quite some time to be accepted as a standard of care. Today the endovascular approach is the preferred procedure to repair an AAA and this is because of the advances in medical devices and dedication of physicians to this less invasive non-surgical approach, physicians who will be attending this year’s VIVA meeting. Continue reading →

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Filed under History, Meetings & Conferences, Peripheral Artery Disease (PAD), Video

October 16, 2014 · 5:03 pm

Fractional Flow Reserve and Ebola: Thresholds and Decision-Making

This week started off with me watching a demonstration of fractional flow reserve (FFR) during multivessel PCI. This very instructive case was transmitted live from Hammersmith Hospital in London and featured Dr. Justin E. Davies showing how to perform FFR and, more importantly, how the use of FFR changed the treatment plan for this patient.

The angiogram had shown three intermediate blockages (LAD, OM, RCA) and, as such, this patient might have been a candidate for CABG instead of PCI. However, when FFR was used to measure whether or not these blockages were ischemic, two were found to be hemodynamically insignificant: it would be safe to defer stenting and treat them medically. The third lesion in the LAD clearly was the cause of the symptoms and stenting would have benefit for the patient. Continue reading →

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Filed under Appropriate Use Criteria (AUC), FAME I / FAME II, FFR, Media Coverage, Stent, Video

October 7, 2014 · 6:34 pm

AimRADIAL Masterclass Comes to Chicago

On October 23-25, 2014 the 3rd Advanced International Masterclass on the Transradial Approach will be held in Chicago and, if you already perform or want to start using the wrist approach to diagnostic or interventional procedures, you need to attend. Where else will you be able to spend two-and-a-half days with the most expert and experienced radial practitioners in the world?

I went to the very successful AimRADIAL course in New York City last fall and witnessed something I hadn’t really seen since the early days of angioplasty: a relatively small meeting (i.e. less than 300) attended by the pioneers of the procedure, cardiologists who have the largest experience in the radial approach, talking among themselves and trading their latest findings and techniques with each other, and sharing this information with the newer generation of physicians in attendance.It felt like an actual community! Continue reading →

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Filed under Global Trends, Innovators, Meetings & Conferences, Patient Experience, Transradial Approach