From the April 2014 issue of HealthCare Business News magazine


“Stents are very expensive. Stents can be very positive for the patient, but if you put stents where you don’t need them, it adds expense to the procedure and adds time to the procedure,” says Tom Watson, senior analyst at MD Buyline.

Previously, physicians decided if the patient needed a stent based upon their own visual assessment with an X-ray, but now they often utilize intra-vascular ultrasound (IVUS) and optical coherence tomography (OCT) to assess without irradiating the patient. With that change, the assessment has moved away from visual cues to a measurement-based metric for lesion size, shape and length.


Boston Scientific’s iLab and Volcano Corporation’s s5 systems are the main IVUS vendors and St. Jude Medical’s ILUMIEN dominates the OCT market. Even though both technologies have become very popular, fractional flow reserve (FFR) is starting to have a big impact as well.

It’s essentially a wire with a pressure transducer on it and it allows the physicians to measure the pressure difference within a small vessel across a blockage. The physicians can then take that pressure difference and calculate how significant the blockage is and whether the patient will benefit from a stent or not.

FFR was introduced in the 1990s by Cardiometrics, but it has only recently gained popularity in stent-based decision making. It was originally a standalone technology, but over the years it has become more refined and is now integrated into IVUS and OCT systems. Volcano and St. Jude are the only companies that have integrated these technologies.

“It became not only a more practical solution to do both, but it was done with the same piece of equipment. [There are] different catheters, but you didn’t have to have another piece of equipment in the lab, you didn’t have to bring in a different introducer,” says Watson.

Also adding to its popularity are clinical trials in the FAME and DEFER studies that have proved that FFR values of less than 0.80 benefit from stenting. Values above 0.80 usually don’t lead to sustainable positive outcomes.

To top it all off, reimbursement might also play a role in it gaining even more popularity. “There’s talk, although it’s not there yet, that reimbursement may hinge on this information in the future as far as being able to validate whether or not a stent actually needs to be implanted before reimbursement is granted,” said Wayne Adams, consumables analyst at MD Buyline.

More advancement
Robots are not something new to the operating room, but they are continuing to make an impact. In the cath lab, there is a robot making percutaneous coronary intervention (PCI) that much easier and efficient.

April 2014 Magazine

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