New tool could prevent needless stents – companion technology to the angiogram

The device uses the same catheter as does the angiogram and it appears to be able to better narrow down where exactly stents are needed and gives an overall better evaluation than relying on the X-Ray alone. Stents are lifesavers when needed by all means, but if new technology can refine exactly how many and where, it could reduce the number, as stents do need to be monitored, so the less number to be monitored, the less that could go wrong or slip out of place. BD

Doctors may be implanting too many artery-opening stents and could improve patient outcomes — and ultimately save lives — if they did more in-depth measurements of blood flow in the vessels to the heart. That's the finding of a study, to be published Jan. 15 in the New England Journal of Medicine, that evaluated the benefits of a new diagnostic tool to measure blood flow and determine whether stenting was the best option.

The study suggests that doctors should go one step beyond the traditional method of relying solely on X-rays from a coronary angiogram to determine which arteries should be stented for patients with coronary artery disease. In many cases, cardiologists will routinely prop open with a stent any arteries that look significantly narrowed on the angiogram, said Fearon. "The problem is you can't always tell from the angiogram whether this is absolutely necessary."

By using a method called "fractional flow reserve," or FFR, which involves inserting a coronary pressure guidewire into the artery, doctors can measure whether blood flow is actually reduced to a dangerous level beyond any apparent narrowing. In certain cases, medication may be a better option to stenting.

"The pressure wire is a thin wire with a sensor near the tip that can measure the pressure of blood flow," Fearon explained. "If the narrowing is truly significant it will cause a drop in blood pressure beyond the narrowing. If the pressure was 80 percent or less than the pressure in front of the narrowing (an FFR value of .80 or less), a stent was implanted."

Researchers found that patients who received the additional blood flow test received one-third fewer stents than the group examined only with an angiogram.

New tool could prevent needless stents and save money, cardiologist says