Doug OrrThe Transcatheter Cardiovascular Therapeutics meeting this month in Washington, D.C., (Sept. 24-28, 2002) promises the opportunity for a long overdue update on the latest research and clinical developments in the world of cardiovascular disease.

From a small start 10 years ago, the TCT meeting has rapidly evolved into a major medical meeting, with an exhaustive focus on the interventional diagnosis and treatment of cardiovascular disease. The work of interventional cardiologists also has changed dramatically in this period, as a fast changing series of interventional tools and diagnostic devices have both entered and exited the cath lab. While the TCT meeting is still relatively young in comparison with other cardiovascular meetings such as the AHA and ACC, its influence in educating a global body of researchers and clinicians is unquestioned today. From this perspective, let’s take a quick look at topics of interest for the upcoming meeting.

What’s New?
One year ago, drug-eluting stents were the No. 1 topic of most discussions. You should expect to again see this topic take top billing as the results of clinical trials continue to arrive, ripe for debate and discussion. Early results from this combination device were extremely positive, but cardiologists have long ago learned the benefit of waiting for the rest of the story to arrive in the form of long-term results. The range of drug coatings has broadened considerably, and smaller companies are now arriving with products to challenge the traditional goliaths in this industry.

Brachytherapy, for treatment of restenosis in currently implanted stents, will likely also be a favorite topic of presenters and attendees. The application of radiation therapy directly at the site of restenosis triggers a complex sequence of events, with generally predictable and favorable results. The long-term utility of this device may be supplanted by the newer versions of drug-coated stents, but cath lab physicians working in the real world appear to need this tool to manage today’s re-stenosed patients.

VP = Vulnerable Plaque
VP appears to be the newest entry in the cath lab jargon book from this year’s meeting, as vulnerable plaque enters the spotlight (yes, there is a website already, Simply put, vulnerable plaque is best described as a highly unstable lesion, generally occluding less than 50 percent of an artery. Vulnerable plaque is likely to rupture if untreated, thus generating a major cardiac event. Almost 50 percent of heart attacks occur in patients with scant ischemia (more new jargon) or without any prior symptoms of chest pain or cardiac episodes, and vulnerable plaque is believed to be the major culprit in these patients. A simple review of an angiogram containing a minor lesion would not likely lead to either a diagnosis or a treatment today. Therefore, the discussion at TCT this year will be expected to focus on the emerging options in diagnosis and treatment of these lesions that today appear to be benign. The first technologies to be applied in diagnosis are intravascular ultrasound and optical coherence tomography, with calculations of pressure and gradients from geometric analysis of the lesion also adding to the diagnostic work-up. Currently, the search is on for lipid-rich lesions with thin fibrous caps — this represents the early focus of vulnerable plaque research.

Molecular Cardiology: Genetics
For the dreamers in the audience at TCT, the world of molecular cardiology will be further explored, especially as it relates to angiogenesis. The option to treat cardiovascular blockages by growing new arteries has stirred interest in both the cardiovascular and cancer communities. The elusive key to this technology appears to be the issue of control of the process, by discovering the means to predictably start and stop the growth of new blood vessels. Many tumors exhibit the quality of angiogenesis, creating new blood vessels to feed the growth of cancerous tissues. Thus the process must be carefully controlled, in order to apply it effectively in treating blockages of normal vessels.

Imaging Too
The cath lab world also is benefiting from the work of well-known imaging equipment manufacturers as cardiac CT and MRI systems enter the mainstream of this cardiovascular meeting. The former x-ray-based “cath lab” will likely be expanded to incorporate a substantial addition of new diagnostic imaging machines that improve their total diagnostic and treatment capabilities. Angiograms are not expected to disappear, but are likely to be broadly supplemented with MRI and CT exams in the next two to three years. On the more traditional side, digital x-ray detectors are expected to become standard order items on most new cath labs by the end of this year — better images from improved contrast range carries a huge impact in these machines.

Finally, if you attend the TCT meeting this year, remember to thank Dr. Martin Leon, TCT director, and president and CEO of the Cardiovascular Research Foundation (CRF) at Lenox Hill Hospital (New York City). His leadership and dedication this past decade have made this meeting the pre-eminent gathering of cardiovascular disease professionals it is. Maybe he also has some ideas and dreams for this meeting’s future 10 years from now as well.

Doug Orr, president of J&M Group (Ridgefield, Conn.), consults with medical device companies in strategy and business development for emerging growth markets, notably radiology and cardiology. Comments and suggestions can be sent to [email protected].