CLINICAL EVENTS CALENDAR
Non-Accredited Education
 CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE On Demand Web ArchiveNon-Accredited Target Audience: Physicians, nurses, and technologists. This activity is supported by an educational grant from Terumo Medical Corporation. |
Journal of Invasive Cardiology Blogs
Drug-Eluting Stent Management Dilemmas II
How Do you Manage the Patient with Recent Drug Eluting Stent Placement Who Requires Urgent Non-cardiac Surgery?
H. Vernon (Skip) Anderson, MD
Engaging Coronary CTO
Venture wire control catheter is a deflectable-tip catheter that is traditionally used to facilitate wire crossing of tortuous coronary vessels, coronary bifurcations, navigate acute bends and side branches jailed by stents. The directional control of the guidewire achieved through this device may also be very useful during engagement of coronary CTO. In this series of upcoming blogs I will be discussing use of specific devices for percutaneous treatment of coronary CTO.
In a report recently published from our group by Iturbe et al the use of Venture catheter has been described along with t
First Look: CLOSURE Trial Preliminary Results
As someone who performs a good number of PFO closures in those believed to be at high-risk of recurrent cryptogenic stroke despite medical therapy, I was certainly interested in hearing preliminary results from the CLOSURE trial released a few weeks ago. Initiated in 2003, during the fledgling days of closure technology and expertise, the study randomized patients with cryptogenic stroke and PFO to closure using the StarFlex device (NMT Medical) versus best medical therapy, the latter comprising full dose aspirin or warfarin at physician discretion.
The study failed to meet its primary endp
Vascular Calcification: Friend or Foe?
“Am I growing bone in my arteries!?” The patient exclaimed, as I explained that the coronary narrowing had a lot of calcium. It has always struck me as a peculiar phenomenon and one that keeps me puzzled as I plow through the endless frames of IVUS analysis. It reminds me, in some ways, of those strange Teratoma tumors that have teeth or bone growing in them. Grey-scale IVUS studies, in the past, have shown us that larger arcs of calcium occur in more stable disease. Recent studies, have shown that spotty calcification on CT angiography may infer a more vulnerable plaque type. We all know
About False Positive STEMI Activations....
I write this blog with caution, as I am afraid I am opening myself up or criticism and ridicule. But I feel as if there is an issue which interventional cardiologists are afraid to raise, except perhaps in venting to sympathetic audiences (spouses and other interventional cardiologists). I have heard the whispered conversations, and have spoken frankly with prominent interventional cardiologists who feel there is an under-addressed issue in our field. This issue is the “problem” of false positive STEMI activations. I put the word "problem" in quotations because I think we are all afraid to
ST Elevation Myocardial Infarction
From the 10th Biennial IAGS Meeting (January 25–31, 2009) South Africa
ST Elevation Myocardial Infarction I
Speakers: Howard Cohen, Michael Mooney
Moderator: William O’Neill
Panelists: George Vetrovec, Adam Greenbaum, Tim Fischell
INTRODUCTION
William O’Neill, MD: We are going to go ahead and shift focus a little bit. I was thinking this morning that one of the great things about this meeting is that sometimes you can get an “ah ha” moment or an insight and I got that yesterday when I was listening to Bonnie (Weiner) speak about messaging. If
Starting a CTO Program
Performing percutaneous CTO interventions is rapidly gaining momentum in the U.S. Though, there is increasing interest from the interventional community at large, initiating a CTO program should be approached with great forethought and planning. In a recent conversation with Dr Bill Lombardi from Bellingham, Washington, it was evident that the leader of contemporary CTO treatment in the U.S. gives this issue significant importance and has come up with certain benchmarks for a CTO operator.
The prerequisite quantity to start CTO PCI is probably 500–1000 non-CTO PCI and then you can really
Calling All Leaders: SCAI’s Emerging Leader Mentorship Program
Back when I was a fellow, my mentors were physicians who masterfully waded through the seas of clinical care, research and education, always able to remain focused on all three visions simultaneously. Historically, such physicians set the benchmark for academic excellence and national leadership. Somewhat naively, I set about my career firmly intent on following in their esteemed footsteps, hoping to make my own contribution to the field.
But how does one do this? I quickly learned that planning an academic career is not as easy as one may think, and the biggest lesson of all was that yo
We will never truly EXCEL until we IVUS
Recently, I was lucky enough to experience the excellent international interventional cardiology conference run by James Margolis MD in Snowmass, Colorado. For me, one of the most interesting talks related to the use of IVUS. J.S Park from South Korea presented very interesting data from the MAIN-COMPARE registry1 showing that IVUS guidance for left-main procedures using DES can have a profound impact on mortality. The risk of 3-year mortality was 60% lower in the IVUS arm versus angiography (Figure 1). Other studies such as Roy et al2 have also proposed that IVUS guidance during PCI may reduc
Insurance Cost for Individuals – Any fixes in sight?
Despite a very political fight, the healthcare bill was passed in the House of Representatives and was signed off by President Barack Obama on March 23, 2010. The bill has to be considered a work in progress and most of us do not know what to really expect in 2014. One of my concerns is the current cost of healthcare insurance. Many of us, who read this journal are employees of small to large corporations. As such we are the beneficiaries of group healthcare plans. If you are an individual and have to purchase your own plan, the cost of getting an equivalent plan would be surprising. For examp
Treating Chronic Total Occlusions
Treatment of coronary chronic total occlusions (CTO) remains a challenge that is the leading cause of failed percutaneous coronary interventional procedures (PCI) and is the leading indication for coronary bypass graft surgery (CABG) referrals. Advent of new and dedicated CTO crossing wires, reentry devices and crossing catheters, combined with new and innovative techniques have led to a significant improvement in success rates of CTO treatment. Use of drug eluting stents (DES) and its use in CTO treatment has allowed long-term durability of the procedural successes.
Despite the emerging e
Revisiting the Gold Standard
Recently, an article came out in the New England Journal of Medicine that got some people talking. The article, entitled “Low Diagnostic Yield of Elective Coronary Angiography”[1], certainly gave the impression that such procedures are unwarranted in the vast majority of patients. But, let’s take a closer look.
The authors used the NCDR database to evaluate patients without a definite indication for coronary angiography. This limited the evaluation to about 20% of all procedures. Not surprisingly, over 80% of them had some sort of noninvasive evaluation for ischemia prior to p
10th Biennial Meeting
Purpose and Overview
Introduction to the Proceedings from the
10th Biennial Meeting of the
International Andreas Gruentzig Society
held January 25–31 in Cape Town, South Africa
From its beginnings at the first gathering at the University of Alabama at Birmingham in 1990, the International Andreas Gruentzig Society (IAGS) has brought together cardiovascular specialists from around the world to honor Andreas Gruentzig and continue the spirit of his innovation that led to the development of coronary angioplasty in the mid 1970’s. Over the years, the attendees of this meetin
The Role for Low-Molecular Weight Heparin after a Cath Procedure
Urban legends intrigue me. They are either very prevalent in medicine, or the challenges of documenting simple, common observations are deeper than it would seem likely. An example is the use of low-molecular-weight heparin after a cardiac catheterization procedure. I am not referring to its use in acute coronary syndromes, which was tested in the ACUITY trial. I am referring to the use of these compounds after a diagnostic study or intervention. This is where the “urban legend” comes in. I have heard several reports that low-molecular-weight heparin has been associated with late v
Introducing the IAGS blog
Visit this space regularly for selected blogs from IAGS members providing updates from the sessions presented during the 10th Biennial IAGS Meeting (held in South Africa in January 2009) and related discussions.
PROGRAM
Drug-eluting Stent Design: Perils, Potential, Progress
Speakers: James Zidar, Campbell Rogers
Moderator: Nickolas Kipshidze
Panelists: Michael Mooney, Thomas Mabin, Jamey Jacobs, Hall Whitworth
Drug-eluting Stent Management Dilemmas I
Speakers: Alfredo Rodriguez, Bonnie Weiner
Moderator: Richard Gray
Panelists: George Vetrovec, J. Jef
Pondering on Paradigms from Across the Pond
Currently, coronary investigation (in the UK) is based on the paradigm of hemodynamics, in which a large coronary plaque causes significant luminal obstruction, symptoms and hypoperfusion of the myocardium. This paradigm has been the cornerstone of our therapeutic approaches to chronic stable angina, acute coronary syndromes and acute myocardial infarction for the last 40 years. Unfortunately, in the majority of cases, this diagnosis comes after a plaque has become significant or ruptured and the patient has been exposed to the risk and ultimately an inferior outcome. Surely, to improve cardio
PFO and Cryptogenic Stroke: Finding Closure
There’s no denying the impact of stroke. Not only is it the third leading cause of death, but it is in many ways more feared than heart disease or cancer. As interventionists, our sights have turned to three controversial procedures: (1) carotid stenting, (2) left atrial appendage isolation, and (3) PFO closure. While the first two concern older patients, the third affects those younger and often in the prime of life, throwing patient and physician fears and preferences into the debate. The argument for PFO closure goes something like this: (1) patients with cryptogenic stroke, especi
Using New Anti-platelet Agents: Are You Ahead of the Curve?
A conversation between two interventionalists:
Subhash Banerjee, MD (VA North Texas and UT Southwestern Medical Center)
& Sunil V. Rao, MD (Durham VA and Duke University Medical Center)
S. Banerjee. With two new ADP receptor antagonists, Prasugrel and Ticagrelor proven better than Clopidogrel is it time for their widespread adoption in patients undergoing PCI? Well, given the history of being ahead of the curve, the interventional community probably has already identified scenarios or strategies to incorporate these agents into practice. Just
An Interventional Cardiologist’s (brief) View on the Health Care Debate
I wonder how many people reading this have the same mixed feelings that I do with regards to the current health-care coverage debate. There are clearly some tremendous advantages which could be realized by making health care available to the currently uninsured, and by making insurance available to people with pre-existing conditions. I have worked at county hospitals directly or indirectly for most of my career, so I have seen the impact of our current lack of universal health care on many members of our society. I have been struck how many employed, hard-working members of society have not b
Cardiology is a Team Sport
In patient care, we all know the best outcomes come with teamwork. A team approach achieves the best care by drawing upon the unique strength of each member to form the ultimate authority or “single voice of action.”
Recently I had an 84 year-old patient with Hypertrophic Cardiomyopathy (HCM) who suffered cardiogenic syncope while driving. I made a tough decision to have my colleague implant an ICD for secondary prevention. Unfortunately, she developed pericardial tamponade, requiring echocardiography, pericardiocentesis, and surgical intervention the next morning for ongoing bleedi
Clopidogrel-Proton Pump Inhibitor (PPI) interaction: Where Do You Stand?
I would submit for starters that drug-drug interaction issues are one of the most vexing, often substantiated by competing claims rooted in plausible pharmacokinetic mechanisms. Nevertheless, each one of us has to find our own version of the truth.
Regarding this issue there unfortunately isn’t an absolute one. This realization manifests on how we practice and what we advise our patients. Well, then this blog should get all of you out there to respond with pithy comments on your take of the evidence presented so far publicly. Also, how justifiable is the position FDA has adopted? Another
Word of Caution: Proving “Less is More” is More or Less Easy
Let’s talk about Comparative Effectiveness, as it seems to be the buzz word of the day. As cardiologists, we’re used to this type of research; in fact, I doubt any other field has performed more randomized controlled trials. But, why call it Comparative Effectiveness? I can’t help but worry that the driving force is less about science than about cost, and therefore really Cost Effectiveness. For a field as rich in innovative and expensive technology as interventional cardiology, this is potentially an important distinction.
One big problem with Comparative Effectivenes
Interventional Cardiology has an Image Problem
Washington state has convened a Health Technology Assessment program to evaluate for therapies which are deemed insufficiently cost-effective for state-sponsored insurance programs to cover. They decided to address drug-eluting stents (as opposed to bare metal stents) and I was invited to be a consultant for this process, along with several other physicians, most of whom were not interventional cardiologists. As we discussed the relative merits of drug-eluting stents versus bare metal stents for a variety of conditions, a consistent theme kept cropping up from those who were not interventio
Cardiology Blogs
All Subscriptions are FREE to qualified cardiology professionals
- Subscribe to:
- Journal
- Digital Journal
- E-News
- RSS feed
Anytown, California
Press Release
— Bethlehem, Pennsylvania – Invatec received 510(k) clearance from the U.S. Food and Drug Administration (FDA) in October to market its Mo.Ma Ultra Proximal Cerebral Protection Device for use during carotid artery stenting (CAS). The device effectively reduces and captures debris released during the stenting procedure to prevent it from traveling to the brain, where it has the potential to cause a stroke.
CME Showcase
 The Use of Remote Robotic Navigation in Complex Arrhythmias Complimentary Accredited Web Archive This activity is designed for electrophysiologists and EP allied professionals. Diagnosing Coronary Artery Disease: Advanced Cardiovascular Imaging Solutions  New Standards of Care for CRMD Antibiotic Protection Complimentary CME Accredited Webcast Dates: November 18, 2008 Time: 6:00 pm ET November 19, 2008 Time: 3:00 pm ET This activity is sponsored by the North American Center for Continuing Medical Education. |
REVIEW OUR OTHER
CARDIOLOGY BRANDS Check out our other resources for healthcare professionals of all specialties.
