Featured Lecture Calls for Integration of New Technologies to Improve Cath Lab Care

The cath lab of the future is attainable now. Specifically, the technologies necessary to improve patient care and reduce cost currently exist and simply need to be integrated together through forward-thinking and innovation, according to a featured lecturer at TCT 2015.

Giora Weisz, MD, of Shaare Zedek Medical Center, Jerusalem, Israel, said the current issue in interventional practice is that “most patients arrive to the cath lab without complete information of the status of their CAD. In most patients, there is disconnect between the anatomic and physiologic degree of severity. Moreover, accurate positioning of stents is difficult and often not precise.”

Additionally, stent selection is often based on “eye-balling,” which can lead to poor choices, he said. “Patients are getting exposed to increasing and accumulative doses of radiation with multiple diagnostic tests and treatments,” Weisz said, adding that contrast media- induced kidney injury “is still a major limiting factor and cause for morbidity and mortality.”

A wide array of technologies

Technologies like coronary computed tomography angiography (CTA), fractional flow reserve measured by CT angiography (FFR_CT) and virtual stenting have all proven helpful in the treatment of contemporary patients with CAD. In fact, he referred to the NXT study, which found that FFR_CT correctly reclassified 68% of CT false positives to true negatives. Also, the PLATFORM study showed that if FFR_CT is used on every single patient, the triple aim of health care — improved clinical outcomes, improved patient experience of care, and reduced costs — are met, Weisz said.

He reviewed the MediGuide guided medical positioning system (gMPS; St. Jude Medical), which is analogous to a GPS system and uses a low-power magnetic field and a sensor to allow for reduced radiation time during procedures. Weisz also described how a hospital in Rotterdam, the Netherlands, successfully integrated CTA with magnetic navigation, allowing them to perform PCI without the use of contrast agents.

Robotic PCI is another expanding technology, he said, and a growing number of U.S. sites are investing in the technology. Moreover, gMPS can be integrated into several robotic PCI cath labs to negate the use of radiation and contrast media and seamlessly bolster efficiency and quality of care, Weisz said.

Lastly, incorporating IVUS and OCT into practice can help to confirm appropriate stent positioning, he noted.

An exciting future

“We can really create a much more robust management of coronary artery disease,” Weisz commented. “And it can happen very quickly if we integrate these technologies together.”

In the future, Weisz predicted, it will be common for patients with chest pain to be evaluated in a “one-stop shop.” For example, CTA will give “high resolution anatomic delineation,” FFR_CT will enable confirmation of physiologic significance of coronary stenosis and quantitative coronary angiography will allow for proper intervention planning. Also, CTA images will be “co-registered” in the cath lab, which will be based on gMPS with no contrast media and no radiation, he said. Lastly, all interventional devices will be “introduced into the coronary artery and positioned by a vascular robotic system” and stent expansion and apposition will be verified by IVUS or OCT, he noted.

 “The suggested novel management of patients with CAD is based on technologies that already exist, are FDA-approved and after further improvement will be combined into a powerful diagnostic and therapeutic system,” Weisz said. “I’m not here to tell what the future will be. The only thing I can promise you is that it’s always more exciting than we can predict.”

Disclosures:

• Weisz reports serving as a medical advisory board member for AngioSlide, AstraZeneca, Calore, Corindus, Medtronic, Medivisor, and M.I. Medical Incentives and receiving grant/research support from AngioSlide and Corindus.