Cath Lab Digest - April 2008 - (Page 57)

57 Lawrence Garcia, MD, principal investigator. “This study provides confirmation. In 100 percent of the lesions, the PressureWire provided a better physiologic assessment of the pressure gradient, without the interference of the obstruction due to the catheter.” Using this low profile PressureWire for arterial pressure measurement yields a more accurate assessment of renal artery stenosis (RAS) and translesion pressure gradients (TPG), than other methods, according to a similar study of 56 RAS patients.2 It reported that diagnoses based on renal angiography and color duplex ultrasound overestimated the severity of RAS by 38 percent and 55 percent compared with those based on a ratio of distal renal pressure to aortic pressure. The study also concluded that this overestimate was likely the cause of disappointing results of renal angioplasty for renovascular hypertension. ■ PressureWire cont. The study, conducted at the Beth Israel Deaconess Medical Center in Boston, is the first to assess this hypothesis in patients with peripheral arterial occlusive disease. “We’ve long suspected that using a 4 or 5 French catheter for measuring pressure gradients would create artifact, simply due to its size relative to the lumen of the vessel,” stated References 1. Garcia LA, Carrozza JP Jr. Physiologic Evaluation of Translesion Pressure Gradients in Peripheral Arteries: Comparison of PressureWire and Catheter-Derived Measurements. J Interv Cardiol 2007 Feb; 20(1):63-65. Drieghe B, Madaric J, Sarno G. Assessment of renal artery stenosis: side-by-side comparison of angiography and duplex ultrasound with pressure gradient measurements. Eur Heart J 2008 Feb;29(4):517-524. 2. Diabetes Medication May Help Slow Progression of Plaque Build-up in Coronary Arteries CATH LAUGHS “You’ve got to hear this!” A comparison of two types of medications to treat type 2 diabetes finds that pioglitazone is more effective at lowering the rate of progression of plaque build-up in the coronary arteries than glimepiride, according to a study in the April 2 issue of JAMA. There is little evidence to support a preference of one class of glucose-lowering medication over any other as a means to reduce the severity of atherosclerotic disease. Sulfonylureas, such as glimepiride, have been available for decades and represent one of the most commonly-used classes of antidiabetic therapy. Thiazolidinediones (TZDs; such as pioglitazone) are a relatively new class of antidiabetic agents. Steven E. Nissen, MD, of the Cleveland Clinic, and colleagues conducted the PERISCOPE trial to directly compare the effectiveness of two alternative approaches for treating hyperglycemia, an insulin-providing strategy (glimepiride) vs. an insulin-sensitizing strategy (pioglitazone), in reducing progression of atherosclerosis in 543 patients with type 2 diabetes and coronary disease. The randomized, multicenter trial included 97 academic and community hospitals in North and South America (enrollment August 2003 - March 2006). The patients underwent coronary intravascular ultrasonography to measure progression of atherosclerosis and were Got a good story or funny one-liner to tell? Would you like to see yourself in the (Cath Lab Digest) funny pages? Mark R. Purpura, cath lab professional and cartoonist, wants to place your funny moment randomized to receive glimepiri- at work into one of his infamous cath lab cartoons. Submit your story, one-liner or just a de or pioglitazone for 18 funny situation in the cath lab to mark@smackpappy.net. months. Atherosclerosis progression was measured by the change in percent atheroma volume (PAV; a measurement of plaque build-up in an artery) with repeat intravascular ultrasonography examination in 360 patients at study completion. The primary efficacy measure, change in PAV, increased 0.73 percent in the glimepiride group and decreased 0.16 percent in the pioglitazone group. An alternative analysis imputing values for patients who did not have follow-up ultrasound procedures and based on baseline characteristics showed an increase in PAV of 0.64 percent for glimepiride and a decrease of 0.06 percent for pioglitazone. A secondary efficacy measure, change in maximum atheroma thickness increased in the glimepiride group and decreased in the pioglitazone group. “Patients randomized to pioglitazone exhibited a lower rate of progression of coronary atherosclerosis across a wide array of prespecified and exploratory subgroups. These finding may have important implications for defining the optimal strategy for management of patients with type 2 diabetes and coronary atherosclerosis,” the researchers conclude. ■ Source: JAMA 2008;299 [13]: 1561-1573. http://www.smackpappy.net

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

Cath Lab Digest - April 2008 Kaiser San Rafael Medical Center Orbital Atherectomy: A New Treatment for Complex Peripheral Arterial Disease Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Contents Clinical Editor’s Corner CEU Education Center The Missing Link in STEMI Interventions — Thrombus Aspiration during Primary Percutaneous Coronary Intervention Predicting Stent Thrombosis Using A Clinical Risk Score Use of a New Guidewire: The Tigerwire Should I Stay or Should I Go? Weighing Options for New Opportunities Navigating Tortuous Coronary Sinus Anatomy Using a Bipolar Lead The National Society of Radiology Practitioner Assistants (NSRPA) Holds 9th Annual Educational Conference For Medical Imaging Physician Extenders and Mid-Level Healthcare Providers Cath Lab & Beyond: A Meeting Update The Ten-Minute Interview with… Dale Hansen RT, CVT Sometimes, You Just Know Twin Circumflex Arteries: A Rare Coronary Artery Anomaly What Do You Think? Meetings Calendar News from the American College of Cardiology (ACC) Scientific Session and the Society of Cardiovascular Angiography & Interventions (SCAI) Annual Scientific Sessions in Partnership with the ACC i2 Summit Clinical & Industry News Cath Laughs Classifieds Advertisers Index

Cath Lab Digest - April 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.