Volcano Corporation Reports Use of IVUS Increasing as Physicians Refocus on Stent Technique

Volcano Corporation summarized the role of intravascular ultrasound (IVUS) in a shifting drug-eluting stent (DES) market. Use of DES has decreased from 89% of percutaneous coronary interventions (PCIs) in the U.S. down to an estimated 70% over the past year, driven by concerns over stent thrombosis, and confidence in bare metal stent (BMS) safety. In the same period, Volcano has seen an increase of 25% in IVUS revenue, demonstrating more reliance on detailed imaging to guide optimal DES and BMS placement.

Martin B. Leon, MD, of Columbia University Medical Center and the Cardiovascular Research Foundation, New York, commented, "The negative press around acute and late stent thrombosis with DES has led physicians to reexamine the safety of stenting and their control over patient outcomes. Interventionalists are now taking two proactive measures to protect their patients; prolonged duration of dual anti-platelet therapy, and increased focus on stent placement technique. This drive to improve patient outcomes, and confirm proper stent expansion and apposition is driving the increased use of detailed imaging modalities like IVUS."

As part of a presentation at the CRT Meeting in Washington DC this month, Renu Virmani, MD, FACC, reiterated five contributing factors to late stent thrombosis that she uncovered as part of her post-mortem study on victims of sudden cardiac death. Dr. Virmani commented, "Histology data has shown that a significant number of sudden cardiac death victims exhibit similar predictors relating to stent placement. These include; discontinuation of anti-platelet therapy, stent mal-apposition, stent struts embedded into a necrotic core, hypersensitivity reaction to the implant, and ostial or bifurcation stenting. More advanced imaging modalities like IVUS can help address three of the five predictors, and in turn, may help reduce the risk of stent thrombosis."

Data suggests that IVUS can improve outcomes in bare metal stenting as well. Peter Fitzgerald, MD, PhD, Professor of Medicine and Engineering and Director of the Center for Cardiovascular Technology at Stanford University, added, "There is substantial evidence that IVUS can help determine the appropriate strategy of stenting, medical therapy or bypass surgery. Additionally, evidence supports IVUS-guided stenting with BMS improves clinical outcomes. Many physicians may have lost sight of this fact with the advent of DES. This current moment of pause in the industry however has led many interventionalists back to established BMS platforms. Regardless of stent type, the value of IVUS guidance is certainly gaining momentum for both DES and BMS procedures."