Thursday, May 20, 2010

Tiny Camera Peeks Inside Coronary Arteries

For a better look inside coronary arteries comes Optical Coherence Tomography (video at link):
Optical Coherence Tomography, or OCT, approved by the FDA in April 2010, forms images by reflecting light inside blood vessels, which allows doctors to see 10 times more detail of an artery than the conventional ultrasound.
Please note that this technology has been around since at least 2002. Is it really new? Or is it really that the company's news of FDA approval is "new?" More importantly, the million dollar question is not if it makes pretty pictures, but rather what does it add to the cost of the procedure and will it improve outcomes?

A brief review of a similar technology, intravascular ultrasound (IVUS), has demonstrated that it's not so easy to demonstrate improved outcomes in most routine cases:
In a systematic literature search (of articles on IVUS), 115 reviews, 10 health technology assessment reports, and 226 relevant primary studies, including 33 economic articles, were identified. 35 clinical and 3 economic studies met the inclusion criteria. In routine intervention with primary stenting, IVUS guidance did not show significant advantages. In specific clinical situations, IVUS information may indicate a change of therapeutic strategy that may benefit patients. Following heart transplantation, IVUS provides additional prognostic value compared to angiography alone. None of the economic analyses included long-term costs or effectiveness. However, after combining cost data with results from the effectiveness meta-analysis, the short-term cost-effectiveness ratio for IVUS-guided intervention was 7700 Euro per prevented major adverse cardiac event (MACE).
Still, the image quality of OCT does appear to be substantially better than IVUS on first glance and it may open another door to our understanding of atherosclerosis.


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