Sept-Oct 2009

Digital Edition
DES Head in a New Direction
The polymer coating on drug-eluting stents (DES) used to carry the antiproliferative drugs cause an increased risk of stent thrombosis, months or even years after a stent is implanted. This has led stent manufacturers to look for or ways to eliminate the vessel irritating polymers for better biocompatibility usually associated with bare metal stents (BMS).
Dissolving Stents May Offer New Options in the Next Decade
Metal stents are foreign objects that can irritate vessels and cause stent thrombosis, prevent vessel remodeling, prevent future surgical interventions, can fatique and suffer strut fractures, and impair CT or MR imaging. For these reasons several stent manufacturers are working on biodegradeble stents that do not leave behind any hardware.
Advancements in Drug-Eluting Stents
Over the past year several new drug-eluting stents (DES) stents have been released and SYNTAX trial data proved DES compare as well as coronary artery bypass graft surgery (CABG) in patient outcomes. DES vs. CABG
New Designs May Ease Bifurcation Stenting
Stenting of lesions at coronary vessel bifurcations is one of the most challenging percutaneous interventions, along with a high risk of procedural complications and restenosis. Several companies are developing specialized bifurcation stents to help make the job easier. Currently there are no dedicated bifurcation stents with FDA clearance.
New Methods to Detect Vulnerable Plaque
Ruptured vulnerable plaque (VP) is blamed for the majority of acute myocardial infarctions and many strokes, but there is extensive debate over which modalities are best suited to detect these plaques, and there is as of yet no conclusive way to determine which of these plaques will rupture.
FDA Clears Effient, May be Serious Competitor to Plavix
In August Daiichi Sankyo and Eli Lilly and Company launched U.S. sales of Effient (prasugrel), a new antiplatelet medication to prevent stent thrombosis, which clinical studies show to be more effective and better tolerated than Plavix (clopidogrel).
Left Main PCI Using LV Support With the Impella 2.5
A 55-year-old woman with a history of heavy alcohol use, hepatitis C induced cirrhosis, hypertension, and chronic renal insufficiency presented at Massachusetts General Hospital in Boston Mass., with nine months of increasing intermittent substernal chest pressure. The pain was inducible by exertion, was nonradiating, and when present associated with shortness of breath, and diaphoresis.
New Trends in the ECG Monitoring
According to the American Heart Association (AHA), arrhythmias afflict more than 4 million patients and results in approximately half a million deaths each year in the United States. Electrocardiography (ECG) measurements, which record and interpret cardiac electrical activity over time, are widely used to detect abnormal heart rhythms.
Trends in Coronary, Carotid and Peripheral Stents
Bare metal stents (BMS) were introduced in 1994 as an improvement over balloon angioplasty alone, which had a high restenosis rate of between 30-40 percent. The cobalt-chromium or stainless steel stents helped reduce restenosis, bringing rates down to about 15-20 percent, but BMS also increased the risk of early in-stent thrombosis shortly following the procedure.
Outpatient Cath Labs Suffer Under a System Favoring Hospitals
A trend that was fueled by cardiologists wanting to gain a larger share of reimbursement fees, while at the same time providing more personalized care to their patients, is beginning to fizzle as reimbursements continue to be cut.
An Introduction to Remote Monitoring Systems for Implantable EP Devices
There is a growing trend in electrophysiology toward remote, home monitoring of implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT) devices, pacemakers and implantable cardiac monitors (ICMs).
Avoiding Drugs, Promoting Re-Endothelialization May be Best Solution for Stent Coatings
When vessels are stretched and ripped via angioplasty balloon expansion, the exposed soft muscle tissue can lead to the proliferation of scar tissue (neointimal hyperplasia) that can reocclude the vessel. Drug-eluting stents (DES) were introduced in 2003 to overcome this issue with anti-proliferative drugs, the same as used to prevent cellular growth in cancerous tumors.