Cath Lab Digest - February 2008 - (Page 42)

SICP PROFESSIONALS OUT IN FRONT FEBRUARY continued from previous page implantation in patients at an increased risk for these events. When we compared IVUS-guided PCI to angiographic-guided PCI, we found the cumulative rate of stent thrombosis at 30 days was 0.5 percent in the IVUS-guided group and 1.4 percent in the no-IVUS group (p=0.045). At one year, we continued to see an important trend, particularly with the rate of definite stent thrombosis, which was 0.7 percent in the IVUS group and 2.0 percent in the no-IVUS group (p=0.014). Target lesion revascularization was slightly higher in the no-IVUS group (7.2 percent vs. 5.1 percent; p=0.06), although this was not statistically significant. Q A What are some ways you feel the information gained by IVUS-guided DES placement may have led to improved clinical outcomes in this study? When you can visualize optimal stent expansion and full lesion coverage, you may often eliminate some of the pathology associated with a higher incidence of stent thrombosis, such as sub-optimal expansion, lack of complete apposition and presence of occult distal dissections. This allows improvement in implantation techniques, which may be in part responsible for decreased rates of stent thrombosis. IVUS also allows you to get an accurate assessment of tissue type and local plaque morphology, giving you the advantage of better tool selection and helping to optimize the final result. Q A What percentage of the time do you feel IVUS gives you valuable information that was not appreciated on angiography? It depends on your experience with stenting, but I think that 30 percent of the time, IVUS adds information beyond angiography that can help optimize the outcome. For example, IVUS makes it easier to assess vessel size and lesion length. Furthermore, it provides information on the degree of calcium in a plaque prior to treatment, which might encourage the use of ablative technologies to improve stent delivery. How have the results from this study influenced the use of IVUS and DES at the Washington Hospital Center, and what role do you see IVUS playing in the future? I think our results encourage the lower-volume operators at our center to use IVUS more frequently. This will probably impact the percentage of patients we evaluate with IVUS, even in a center in which IVUS is already used in greater than 70 percent of lesions. What advances have you seen in IVUS technology over the last several years? We have seen a dramatic improvement in image quality. I particularly like the Boston Scientific system because it gives very good gray-scale characteristics. Lower-profile catheters now feature improved deliverability, and interpretation software has become more automated and faster. Finally, the incorporation of IVUS as a permanent part of the cath lab should increase a user’s comfort level with the technology and help them to use it more efficiently. Do you see any clinical relevance with tissue characterization? Not yet. Most of the data are very speculative, and it is still too early to determine what this technology has to offer. Currently, I would much rather have a higher-resolution, better grayscale image with which I can characterize plaque morphology than a multi-colored image that cannot be used to predict outcomes. Sponsored and prepared by Boston Scientific Corporation through. I can honestly say that I now have the best staff I have ever worked with in my career. They are very intelligent and they “own” their area. They are supportive and initiate change in our labs. They are my motivation on days that are low for me as a director. I am very proud to be working with such a great team! Are you involved with the Society of Invasive Cardiovascular Professionals (SICP) or other cardiovascular societies? Yes, I have been elected co-chairperson of the Jubilee Chapter here in the Mobile area. I am excited to be working with a new chapter as well as Ernie Livingston, RN, BSN, who is the elected chairperson. Although our chapter is new, we have a lot of support and attendance from all of the local hospitals. Are there websites or texts that you would recommend to other cath labs? I would recommend that any organization get involved in the Cardiovascular Roundtable (The Advisory Board Company, Washington, D.C.), TCT (Transcatheter Cardiovascular Therapeutics), and Peripheral Angioplasty and All that Jazz conferences. Do you remember participating in your first invasive procedure? I remember when we deployed our first stent in a coronary artery at Vanderbilt. It was exciting for everyone involved in the case. I was so proud to be on the leading edge of technology. It was almost as if you could hear a pen drop in the room. We all were so quiet and trying to keep our excitement down without disturbing the physician. It seemed like everyone was in the room…nurses, cardiovascular surgeons, technologists and administration in the control room. Wow…what an experience! If you could send a message back to yourself at the beginning of your cardiovascular lab career, what advice would you give? I would tell myself to learn the details of each procedure. I would focus more on the cellular level and understand why and how the physician makes the decision he/she makes. It is so overwhelming when you start, so I would tell myself to slow down and take the time to learn it all. It is not something you are going to learn overnight. Experience comes with time. Don’t be afraid to ask questions. Where do you hope to be in your career when it is time to retire? I see myself in an administrative role, hopefully at a point where I have developed relationships and skills that as a leader, I have fostered growth and development of that organization so that it is recognized as a center of excellence. I look forward to the challenges and opportunities that any job may provide. I hope to leave a legacy of being a great leader with a winning team. I know that I can accomplish this because the philosophy of and commitment to excellence is what I believe in. Has anyone in particular been helpful to you in your growth as a cardiovascular professional? I would have to say that there have been two people in my career for whom I have the utmost respect and admiration. Robin Steaban, the cardiology administrator at Vanderbilt University Hospital in Nashville, Tennessee, was instrumental in developing my management and computer skills early on in my career as a new manager. She always strived for excellence and had the ability to motivate you to a higher level. She was a mentor and a friend. The second individual would be my current administrator, Alan Holley, at the Mobile Infirmary Medical Center. He supports you when needed but does not micro-manage any area that is under his direction. He is wellrespected by his peers and all the directors under his leadership. He gives positive feedback and has the talent to motivate you when needed. He is a very visible leader and knows all of the staff and supports them as well. I have been very blessed to have had two different leaders influencing my career in cardiology. Where is the invasive cardiology field headed in the future? We are going to have some really exciting times in the world of cardiology. The invasive side of cardiology will continue to explode with new and improved technology. I can also see less invasive procedures, and hopefully, new and improved drugs that will help with heart disease. I think the dynamics of the business will change based on future elections, mergers and industry changes. Reimbursement will also be a driving factor for cardiology. All we can do is sit back and ride the wave of new technology. I am looking forward to seeing how the industry changes and how we will manage these changes. ■ Q Q A Q A Debbie Charlton can be contacted at drcharlton@mobileinfirmary.org

Table of Contents Feed for the Digital Edition of Cath Lab Digest - February 2008

Cath Lab Digest - February 2008 Bay Regional Medical Center ENDEAVOR IV: A Zotarolimus-Eluting Stent Versus a Paclitaxel-Eluting Stent in a Randomized Clinical Trial A 3D CT Vessel “Roadmap” Over Live Fluoroscopy for Chronic Total Occlusions Contents Clinical Editor’s Corner An Evaluation of Cath Lab Turnaround Time Commentary: An Evaluation of Cath Lab Turnaround Time Excerpts from Chapter 19. STEMI Interventions – Future Perspectives The Potential Clinical Utility of Intravascular Ultrasound Guidance in Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents The Ten-Minute Interview with…Debbie Charlton, RN The Society of Invasive Cardiovascular Professionals (SICP) at Transcatheter Cardiovascular Therapeutics (TCT) 2007 The Cath Lab is a Business: Do You Have the Knowledge to Stay Afloat? Incidence and Predictors of Vascular Complications after Invasive Coronary Procedures: A Prospective Analysis Ask the Clinical Instructor: A Q&A Column for those New to the Cath Lab Volunteer Survey SICP* Section Meetings Calendar What Do You Think? CEU Education Center Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - February 2008

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