Feature | November 18, 2013

SCAI Outlines Best Uses for Intracoronary Diagnostic Tools in Interventional Cardiology

Recommendations guide use of FFR, IVUS and OCT in treatment of complex heart disease

intravascular imaging ffr ultrasound ivus optical coherence tomography oct cath
November 18, 2013 — In an expert consensus document e-published in Catheterization and Cardiovascular Interventions (CCI), the Society for Cardiovascular Angiography and Interventions (SCAI) offers recommendations for optimal use of three technologies that interventional cardiologists often use to assess the severity of blockages in heart arteries. To ensure these technologies are applied in a manner most beneficial to patients, SCAI has issued guidance on fractional flow reserve (FFR), intravascular ultrasound (IVUS) and optical coherence tomography (OCT), three tools for improved patient care, particularly for patients whose heart disease is considered complex or whose disease levels are unclear from angiography.
 
“Physicians will find these recommendations helpful as they apply these techniques to help patients with more complex cases or who have tests that contradict one another,” said Lloyd Klein, M.D., FSCAI, professor of medicine, Rush University Medical Center, Chicago and lead author. “Many patients will not need these techniques in their care, but for those who will benefit from them, this guidance offers physicians the parameters to ensure they are put to use best.”
 
General information
FFR is a procedure for measuring how much blood flow is restricted by a blockage in an artery using a pressure-sensing guide wire fed through a catheter to the site of the blockage in an artery. When placed across the blockage, the wire measures the flow and pressure of blood before and after the blockage. IVUS, a form of ultrasound, uses sound waves to create images of the inside of arteries to determine if a blockage is present, and if so, how severe the blockage is. OCT is an imaging method for taking high-resolution pictures of blood vessel walls. Approved in 2010 for cardiac use in the United States, OCT provides detailed images of build-up of cholesterol and other materials in blood vessel walls that can rupture, causing a blood clot to form and block off critical blood flow. All three techniques are typically applied during an angiogram to help interventional cardiologists assess the severity of the disease inside heart arteries.
 
The expert consensus document reviews each of the three technologies in terms of level of benefit to patients. This categorization offers physicians perspective on the best current uses of each test, where no proven benefit has been shown and where there may be potential for benefit once more information is gathered over time. Highlights include:
 
Benefits of FFR
  • In patients with complex heart disease, angioplasty with FFR measurement improves outcomes and saves resources when compared to angioplasty guided by angiography alone.
  • Knowing the FFR measurement may help guide decisions on whether to perform angioplasty or open-heart bypass surgery and whether a patient needs urgent in-hospital care to open blocked arteries versus medication alone.
 
Benefits of IVUS
  • IVUS helps to accurately determine how well a stent is placed in an artery, ensuring a proper fit based on the size of the artery.
  • IVUS can be used with certain types of blockages to help determine whether a patient will need revascularization to open a blocked artery. The authors note that IVUS should not be used to determine the severity of certain types of heart disease.
 
Benefits of OCT
  • OCT is beneficial to determine how well a stent is placed, with improved imaging compared to IVUS, and can be useful in assessing changes in plaque that block the arteries.
  
The paper, titled “Expert Consensus Statement on the Use of Fractional Flow Reserve, Intravascular Ultrasound, and Optical Coherence Tomography” is available at on SCAI’s website.
 
For more information: www.scai.org

Related Content

Feature | Business| April 28, 2016 | Dave Fornell
 
Technology | Stents Peripheral| April 27, 2016
Veniti Inc. announced the first successful treatment with the Vici Verto Venous Stent System of a patient suffering...
Auris Surgical Robotics, acquisition, Hansen Medical
News | Robotic Systems| April 26, 2016
Auris Surgical Robotics Inc. and Hansen Medical Inc. announced that they have signed a definitive merger agreement...
Siemens Sensis Vibe, hemodyanamics system

Siemens released the Sensis Vibe hemodyanamics system at ACC.16. The newer system offers better integration of cath lab data into cath lab reports and the electronic medical record (EMR).

Feature | ACC| April 25, 2016 | Jon Brubaker, MBA, RCVT, Tom Watson, BS, RCVT, and Sabrina Newell MS, RCS
There were several trends seen in new cardiovascular technologies showcased on the expo floor at the 2016 American...
Medtronic, Drug-Filled Stent, RevElution Trial results, ACC.16, CE Mark
News | Stents Drug Eluting| April 21, 2016
Medtronic plc announced new clinical data from one of the endpoints in the RevElution Trial for its novel, next-...
Boston Scientific, Fetch 2 aspiration catheter, Class 1 recall
News | Thrombectomy Devices| April 20, 2016
April 20, 2016 — Boston Scientific Corp. announced a U.S.
ischemic postconditioning, STEMI patients, clinical outcomes, ACC.16
News | Cath Lab| April 19, 2016
A large randomized controlled trial of ischemic postconditioning in patients who had experienced ST-segment elevation...
STEMI, delayed or deferred stent implantation, DANAMI-3-DEFER trial, ACC.16
News | Cath Lab| April 18, 2016
Delayed or deferred stent implantation in patients showed no clinical benefit in patients experiencing the deadliest...
ACR, American College of Radiology, MEDCAC, peripheral arterial disease, PAD, seniors
News | Peripheral Arterial Disease (PAD)| April 18, 2016
The American College of Radiology (ACR), as a member of a coalition of leading medical societies, provided peripheral...
FFR-CT, heartflow
Feature | CT Angiography (CTA)| April 15, 2016 | Jeff Zagoudis
Fractional flow reserve-computed tomography (FFR-CT) is still in the early stages of clinical implementation in the U
Overlay Init