Guidance for Using Intracoronary Diagnostic Tools

Guidance for Using Intracoronary Diagnostic Tools

As technology has advanced, intracoronary physiology assessments and imaging are increasingly being used in the management of patients with severe coronary stenosis. This shift in diagnostic use has been necessitated because of limitations when interpreting coronary angiography, which has been the traditional method for determining the severity of coronary stenosis. “The diagnostic effectiveness of coronary angiography is limited by inter-observer variability, even among the most experienced angiographers,” says Lloyd W. Klein, MD, FSCAI. Fortunately, several additional adjunctive techniques have emerged to further assist clinicians who care for these patients. In recent years, three diagnostic procedures have emerged that can improve decisions for coronary revascularization, guide the performance of PCI, and optimize procedural outcomes. These procedures include: 1) fractional flow reserve (FFR), 2) intravascular ultrasound (IVUS), and 3) optical coherence tomography (OCT). FFR is used to determine the functional significance of a coronary stenosis. IVUS offers excellent visualization of the intraluminal and transmural coronary anatomy. OCT was approved for use in the United States in 2010. It further improves vascular visualization to help determine causes of blood clots and blockages of critical blood flow.   “There is now persuasive evidence regarding intra-coronary diagnostic lesion assessments using these adjunctive diagnostic procedures,” adds Dr. Klein. “However, research suggests that these techniques are underutilized in contemporary practice.” Consensus Recommendations In 2011, the American College of Cardiology, American Heart Association, and Society for Cardiovascular Angiography and Interventions (SCAI) released joint guidelines for using PCI, but a deeper analysis of the available literature was necessary to guide clinicians when using FFR, IVUS, and OCT. In 2013, SCAI issued a consensus statement that reviewed recent studies on these diagnostic...

Conference Highlights: The American Academy of Orthopaedic Surgeons 2011

This feature highlights some of the studies that emerged from the 2011 AAOS annual meeting, including data supporting the long-term function of total knee replacement (TKR), imaging costs linked to defensive medicine, PE risks after knee arthroplasty, and the effect of stretching before running. » TKR Improves Function for the Long-Term » PE Risks After Knee Arthroplasty » Are Two TKRs Better Than One? » The Effects of Stretching Before Running » Imaging Costs Linked to Defensive Medicine TKR Improves Function for the Long Term The Particulars: Most patients who undergo total knee replacement (TKR) are between the ages of 60 and 80. More than 90% of these individuals experience a dramatic reduction in knee pain and a significant improvement in their ability to perform common activities. However, questions have been raised about the decline in physical function over the long term despite the absence of implant-related problems. Data Breakdown: Between 1975 and 1989, a study looked at TKRs performed in 128 patients who were living at 20 years follow-up. The average age at operation was 63.8. Of the study participants, 95 could walk at least five blocks when assessed at 20 years follow-up, and 48% reported unlimited walking ability. All but two patients could negotiate up and down stairs without a banister. Only three patients were considered housebound, and no implant failures were observed after 20 years. Take Home Pearls: Elderly recipients of TKR appear to be using their surgically replaced knees for fairly active lifestyles many years after surgery. This study refutes the perception that well-functioning TKRs diminish over time because of an overall declining functional status. PE Risks After...