Integrated approach for innovative solutions
"Primum non nocere" or "first do no harm" has long been a principal tenet of medical training. Knowing when not to treat is just as important as knowing when treatment is required.
When it comes to definitive diagnosis and ultimately treatment, the best approach is an integrated approach. This takes into consideration the level of risk for PCI over invasive surgery and uses precision diagnostic tools that provide clinicians with a holistic view of the entire patient’s condition. We aim to provide interventional cardiologists with integrated solutions that not only allow real-time image guidance, but also a precise and detailed “roadmap” of the vessels of the heart, which can be closely monitored throughout the entire PCI procedure. Watch a recent session on complex PCI approaches to learn more.
Fractional flow reserve (FFR)* has been a revolution in helping physicians decide when to treat coronary lesions. Some can appear significant on angiogram when they are truly non–flow limiting and we have seen a positive trend over the last decade to transition from only angiographic-guided treatment to one with support of physiologic-guided treatment. FFR is a tool that gives the ability of true physiological assessment of the coronary vessel. The landmark DEFER study has now shown with 15 years of robust patient follow up, that by using FFR to help decide when not to perform PCI in single vessel disease, we can actually lower a patient's risk of myocardial infarction. In other words, “primum non nocere.”
Despite strong outcome data, FFR is still underutilized, partially because of workflow challenges related to physicians having to inject vasodilators like adenosine to induce hyperemia. Instant wave-free ratio (iFR)** is a novel technology that now improves the FFR workflow by eliminating this additional step, and also the cost of the FFR vasodilator. These technologies are a win-win as they help physicians not only treat patients, but also help our society realize cost benefits, by reducing unnecessary treatments and hospital readmissions.
Philips has integrated this approach with its intravascular ultrasound (IVUS)*** guidance. By meaningfully co-registering the IVUS and angio images together, this can help reduce the risk of not completely treating a lesion with a single stent – so called "geographic miss", which study data suggests may occur in 66.5% of PCIs. Of course having to place a second stent adds not just complexity to the case, but also cost. If FFR/iFR indicates stenting is warranted, Intravascular imaging technology confirms if the stent has been placed appropriately or needs a "touch-up".