Lesson 3
22. Tons of New
Therapies
"My interventional cardiologist is different
from the ones you are talking about. He uses the latest thing."
Well, in a series of randomized trials the latest things which
included: Covered stent grafts had a worse outcome in native vessels,
saphenous vein grafts, and perforated coronaries. Beta-radiation
therapy for treatment of in-stent restenosis, debulking prior
to beta-radiation, cutting balloons, X-Sizer, Heparin eluting
stents, low pressure stents, Intravascular low power laser photostimulation,
and Excimer laser coronary angioplasty (ELCA) all had either no
advantage or worse outcomes. Many of the worse outcomes were things
like death. New, new is not always better.
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New Therapy of the Day
- Covered
stent grafts?
In native vessels? Worse outcome
In saphenous vein grafts? Worse outcome
In coronaries that you punctured with the PCI wire?
Bad problem, which you can salvage, if they don’t die.
important anchor for bail out situations.
Schachinger V, Zeiher AM Covered stent grafts: role in intervention
of coronary arteries and degenerated vein grafts. Z Kardiol.
2002;91 Suppl 3:58-63. Covered stent grafts: role in intervention
of coronary arteries and degenerated vein grafts.
- Beta-radiation
therapy for treatment of in-stent restenosis: Worse outcome
(death)
- Debulking
prior to beta-radiation: Worse outcome
- Cutting
balloon is a new device for coronary angioplasty
Complication 5%, MI 3%, CABG 1%, CABG 6 months 8.5% Auer et.
al. J Interv Cardiol. 2003 Feb;16(1):15-21
- X-Sizer:
Safety of a novel device
Death 2%, MI 4%, Complication 6%, Stone et. al. Catheter Cardiovasc
Interv. 2003 Apr;58(4):419-27
- Heparin
eluting stents?
No benefit demonstrated Haude et. al. Circulation. 2003 Mar
11;107(9):1265-70
- Low pressure
stents?
No benefit demonstrated Brenner et. al. J Invasive Cardiol.
2003 Mar;15(3):128-32
- Intravascular
low power laser photostimulation:
No demonstrated effect Derkacz Med Sci Monit. 2003 Jul;9(7):CR335-9
- Excimer
laser coronary angioplasty (ELCA) Dahm Lasers Med Sci. 2001;16(2):84-9
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