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The Beta Blocker and Clonidine Protocol

Lesson 3
Risk Stratification

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.

Hammurabi - Sumerian Stud!

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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Content by Art Wallace MD PhD
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