Nieuw middel kan onnodige plaatsing stents voorkomen
Doctors may be implanting too many artery-opening stents and could improve patient outcomes — and ultimately save lives — if they did more in-depth measurements of blood flow in the vessels to the heart. That's the finding of a study, to be published Jan. 15 in the New England Journal of Medicine, that evaluated the benefits of a new diagnostic tool to measure blood flow and determine whether stenting was the best option. "Not only were the outcomes better, the cost was less," said William Fearon, MD, co-principal investigator of the multicenter international study called FAME and assistant professor of cardiovascular medicine at the Stanford University School of Medicine. "Now there's scientific support for cardiologists to apply this new technique." Nico Pijls, MD, PhD, professor of cardiology at Catharina Hospital in The Netherlands, was the other co-principal investigator. The study suggests that doctors should go one step beyond the traditional method of relying solely on X-rays from a coronary angiogram to determine which arteries should be stented for patients with coronary artery disease. In many cases, cardiologists will routinely prop open with a stent any arteries that look significantly narrowed on the angiogram, said Fearon. "The problem is you can't always tell from the angiogram whether this is absolutely necessary." By using a method called "fractional flow reserve," or FFR, which involves inserting a coronary pressure guidewire into the artery, doctors can measure whether blood flow is actually reduced to a dangerous level beyond any apparent narrowing. In certain cases, medication may be a better option to stenting.
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