When is a “Good Result”, Just Not Good Enough?
- Tue, 11/22/11 - 3:31pm
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I am currently analysing the IVUS images for angiographically-guided stent placement in my trial: The Liverpool V-HEART study (Virtual-Histology Evaluation of ACS Requiring Treatment)
“No Noble Thing Can Be Done Without Risk” — Exploring the Dark Side of PCI
- Wed, 6/8/11 - 8:44am
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As interventional cardiologists, we don’t tend to focus on negatives very often. However, percutaneous coronary intervention comes with a palpable level of imminent and future risk. It is therefore wise to inform the patient of every eventuality.
Do we have the COURAGE to stop using percentage stenosis?
- Wed, 3/9/11 - 4:59pm
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It has been a year since my first blog and in honor of this occasion; I have decided to pose a controversial question. The 2-year follow-up data from the FAME (Fractional Flow Reserve versus Angiography for Multi-vessel Evaluation) trial [1] shows that patients with coronary artery disease undergoing PCI guided by pressure-wire have significantly fewer adverse events.
PROSPECT and the Gumpian Theory of Atherosclerosis
- Tue, 2/1/11 - 10:21am
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With the recent publication in the NEJM of the long awaited PROSPECT trial,[1] I have been literally “Pondering across the pond” about the implications of this landmark trial. Should we just give up on the vulnerable plaque hypothesis? Steve Nissen has been saying this for a few years now and he is a smart chap.
Desperate Times, Desperate Measures: The ZEN trial – Will it Ultimately Flop?
- Fri, 10/15/10 - 9:55am
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Pondering Across the Pond
Desperate Times, Desperate Measures: The Zen trial — Will it Ultimately Flop?
Vascular Calcification: Friend or Foe?
- Wed, 6/23/10 - 5:20pm
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“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
We will never truly EXCEL until we IVUS
- Mon, 4/12/10 - 12:17pm
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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
Pondering on Paradigms from Across the Pond
- Tue, 3/2/10 - 3:20pm
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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
