This project tracks the development of coronary artery disease interventions, ranging from early method of cardiac bypass to balloon angioplasty to the development of biomedical stents. Analyses of the competitive climate in the biomedical stents industry is discussed. New market and technology strategies are proposed for a regional MNC to leverage domestic industry infrastructure within emerging economies accompanied by a projected 30% growth in CAD due to increased consumption trends and lifestyle factors, e.g. smoking.
Stent design aspects and coronary artery disease were discussed. Coronary artery disease is a leading cause of death worldwide. Historical developments in treatments including balloon angioplasty, bare metal stents, and drug-eluting stents were covered. Mechanisms of in-stent restenosis and approaches to prevent it such as mechanical techniques, drug coatings, and biodegradable stents were described. Clinical measures for evaluating restenosis outcomes were defined.
This document discusses different types of coronary stents. It describes how stents are metal mesh tubes that open blocked arteries. It then categorizes stents based on their material, design, and drug coatings. Some key types discussed are drug-eluting stents, which slowly release drugs to prevent reblockage, and biodegradable stents, which dissolve over time leaving no permanent implant. The document provides details on stent structure, composition, coatings, and examples like the Abbott Absorb stent, a bioresorbable vascular scaffold.
This document discusses stent design and the features of an innovative new stent called EluNIR. It summarizes:
1) EluNIR has a unique design with wide "W" struts that provide excellent radial strength and narrow "Z" struts that provide flexibility and conformability.
2) The optimal scaffolding area of EluNIR provides uniform support and drug elution while preventing tissue prolapse.
3) EluNIR's flexible closed cell configuration and narrow strut width of 40/72 microns allows it to maintain natural vessel curvature after implantation and facilitate stent apposition and deliverability.
This document discusses the design of drug-eluting stents (DES). It outlines the key components of a DES including the platform (materials, design), drug, drug-eluting matrix, and fabrication techniques. The platform discusses factors like strength, deliverability, and hemodynamics. Drug options and targeted drugs are presented. Drug-eluting matrices can be durable polymers, degradable polymers, or porous ceramics. Fabrication involves laser cutting, coating, crimping, and packaging. Risks of DES like hypersensitivity, restenosis, and thrombosis are also reviewed.
This document discusses different designs of coronary stents. It begins by providing background on the development of coronary stents and their approval for use. It then describes some of the earliest stent designs, including the Gianturco-Roubin coil stent and the Palmaz-Schatz slotted tube stent. The document goes on to discuss various aspects of stent design that can impact performance, such as the geometric configuration, materials used, coatings, and drug-eluting capabilities. Key design considerations like strut thickness, number of struts, and mechanical properties are also reviewed.
A stent is a small, expandable tube. During a procedure called angioplasty, the stent is inserted into a coronary artery and expanded using a small balloon. A stent is used to open a narrowed or clotted artery.
This document discusses the history and development of coronary stents. It notes that the introduction of angioplasty led to the development of stents to address the problem of restenosis. Early stents were bare metal, but drug-eluting stents were developed to further reduce restenosis rates by preventing neointimal growth. The document covers the various types of stents developed over time including differences in materials, coatings, and platforms. It also discusses the rationale for biodegradable stents which aim to eliminate complications from permanent metal implants.
This document discusses vascular stents. It begins by defining stents as small tubular meshes inserted into stenotic arteries to keep them open after procedures like PTCA. It then reviews the history of stents from Dotter's early experiments to the development of the Palmaz stent. The document discusses factors that can lead to in-stent restenosis like thrombosis, intimal hyperplasia, and mechanical/flow disturbances. It proposes solutions to these issues such as drug-coated stents and compliance-matching stent designs. The author's PhD project involves in vivo testing of a compliance-matching stent design to reduce restenosis compared to other stents.
Stent design aspects and coronary artery disease were discussed. Coronary artery disease is a leading cause of death worldwide. Historical developments in treatments including balloon angioplasty, bare metal stents, and drug-eluting stents were covered. Mechanisms of in-stent restenosis and approaches to prevent it such as mechanical techniques, drug coatings, and biodegradable stents were described. Clinical measures for evaluating restenosis outcomes were defined.
This document discusses different types of coronary stents. It describes how stents are metal mesh tubes that open blocked arteries. It then categorizes stents based on their material, design, and drug coatings. Some key types discussed are drug-eluting stents, which slowly release drugs to prevent reblockage, and biodegradable stents, which dissolve over time leaving no permanent implant. The document provides details on stent structure, composition, coatings, and examples like the Abbott Absorb stent, a bioresorbable vascular scaffold.
This document discusses stent design and the features of an innovative new stent called EluNIR. It summarizes:
1) EluNIR has a unique design with wide "W" struts that provide excellent radial strength and narrow "Z" struts that provide flexibility and conformability.
2) The optimal scaffolding area of EluNIR provides uniform support and drug elution while preventing tissue prolapse.
3) EluNIR's flexible closed cell configuration and narrow strut width of 40/72 microns allows it to maintain natural vessel curvature after implantation and facilitate stent apposition and deliverability.
This document discusses the design of drug-eluting stents (DES). It outlines the key components of a DES including the platform (materials, design), drug, drug-eluting matrix, and fabrication techniques. The platform discusses factors like strength, deliverability, and hemodynamics. Drug options and targeted drugs are presented. Drug-eluting matrices can be durable polymers, degradable polymers, or porous ceramics. Fabrication involves laser cutting, coating, crimping, and packaging. Risks of DES like hypersensitivity, restenosis, and thrombosis are also reviewed.
This document discusses different designs of coronary stents. It begins by providing background on the development of coronary stents and their approval for use. It then describes some of the earliest stent designs, including the Gianturco-Roubin coil stent and the Palmaz-Schatz slotted tube stent. The document goes on to discuss various aspects of stent design that can impact performance, such as the geometric configuration, materials used, coatings, and drug-eluting capabilities. Key design considerations like strut thickness, number of struts, and mechanical properties are also reviewed.
A stent is a small, expandable tube. During a procedure called angioplasty, the stent is inserted into a coronary artery and expanded using a small balloon. A stent is used to open a narrowed or clotted artery.
This document discusses the history and development of coronary stents. It notes that the introduction of angioplasty led to the development of stents to address the problem of restenosis. Early stents were bare metal, but drug-eluting stents were developed to further reduce restenosis rates by preventing neointimal growth. The document covers the various types of stents developed over time including differences in materials, coatings, and platforms. It also discusses the rationale for biodegradable stents which aim to eliminate complications from permanent metal implants.
This document discusses vascular stents. It begins by defining stents as small tubular meshes inserted into stenotic arteries to keep them open after procedures like PTCA. It then reviews the history of stents from Dotter's early experiments to the development of the Palmaz stent. The document discusses factors that can lead to in-stent restenosis like thrombosis, intimal hyperplasia, and mechanical/flow disturbances. It proposes solutions to these issues such as drug-coated stents and compliance-matching stent designs. The author's PhD project involves in vivo testing of a compliance-matching stent design to reduce restenosis compared to other stents.
interventional cardiology, Guiding catheters, wires, and balloons equipment...salman habeeb
This document provides an overview of guiding catheters, guide wires, and balloons which are core equipment used in percutaneous coronary interventions (PCI). It describes the design characteristics, advantages, and disadvantages of over-the-wire and rapid exchange balloon catheters. Key attributes of balloons like entry, tracking, and compliance are defined. Guiding catheters are discussed in terms of size, shape, and selection for accessing different coronary arteries. Finally, guide wire features such as core material, coating, and tip design are reviewed alongside common wire types used in various clinical scenarios.
Distal balloon occlusion devices and distal filter devices are the main types of embolic protection devices (EPDs) used during percutaneous coronary intervention (PCI). Distal balloon occlusion devices use a balloon to occlude blood flow distal to the lesion during PCI, while distal filter devices use a nitinol mesh filter to capture debris without interrupting blood flow. Major trials have shown the benefits of EPDs for saphenous vein graft interventions and for STEMI patients undergoing PCI. EPD selection depends on lesion location and vessel characteristics. EPDs are recommended for saphenous vein graft PCI but their routine use is not supported for native coronary artery PCI.
I. A coronary stent is a mesh tube placed in arteries to treat heart disease and keep arteries open. It is implanted via angioplasty.
II. Stents are implanted by threading a balloon catheter into the heart and inflating the balloon to expand the stent against the artery wall.
III. While generally safe, potential risks of stents include blood clots, infection, and re-narrowing of the artery known as restenosis.
How to deal with CALCIFIED CORONARY ARTERY LESIONS .Coronary artery calcification (CAC) is highly prevalent in patients with coronary heart disease (CHD) and is associated with major adverse cardiovascular events. There are two recognized type of CAC—intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary intervention have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD patients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.
The document summarizes the expanding clinical applications of endovascular aneurysm repair (TEVAR) beyond its original use for descending thoracic aneurysms. It discusses how TEVAR is now being used to treat a wider range of thoracic aortic pathologies including dissections, ulcers, trauma, and various complex aneurysms. The document also explores new techniques like branched endografts and debranching procedures that are pushing the anatomic limits of TEVAR proximally and distally. While noting some limitations, it presents data showing TEVAR has led to reduced mortality, complications, and hospital stay compared to open surgery for many thoracic aortic conditions.
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
This document discusses chronic total occlusion (CTO) of coronary arteries. It defines CTO and differentiates it from functional occlusions and pseudo-occlusions. The prevalence of CTO is estimated to be around 15% based on registry data. CTOs present technical challenges for percutaneous coronary intervention (PCI) due to factors like lesion length, calcification, and tortuosity. Proper preparation is important for CTO PCI, including adequate guide support and anticoagulation. Scoring systems can help predict the difficulty of crossing a CTO. Special guidewires and techniques may be needed depending on the lesion characteristics and collateral pathways.
This document discusses different techniques for percutaneous coronary intervention (PCI) of bifurcation lesions. It begins by defining a bifurcation lesion and classifying them using the Medina classification system. It then describes commonly used PCI strategies such as provisional stenting, crush, culotte, T stenting, and kissing stents. Several studies comparing outcomes of single versus two stent techniques and crush versus culotte are summarized. The document concludes by emphasizing keeping PCI procedures for bifurcation lesions safe, simple and swift.
Guide catheters in coronary interventionRohitWalse2
Guide catheters are essential for coronary interventions as they deliver hardware into the arteries. The document discusses the properties and types of guide catheters, highlighting how their structure provides support and torque control. It describes commonly used guide catheters like the Judkins, Amplatz and EBU catheters, noting what vessels each is best suited for. Specialty guide catheters for difficult anatomies are also reviewed. Proper guide selection and positioning are emphasized for coaxial engagement and optimal device delivery during interventions.
TAVR SAVR evolution of a groundbreaking therapyLuisArturo RV
TAVR has evolved from its first human implantation in 2002 to becoming a standard treatment for aortic stenosis. Pivotal clinical trials showed TAVR was superior to medical management for inoperable patients and non-inferior to SAVR for high-risk patients. Later trials found TAVR non-inferior to SAVR for intermediate-risk patients. The latest PARTNER 3 and Evolut trials found TAVR non-inferior and even superior to SAVR for low-risk patients, with lower rates of rehospitalization, stroke, and better functional improvement. Ongoing developments aim to reduce vascular complications, permanent pacemaker rates, and expand TAVR to younger patients. T
1. Significant unprotected left main coronary artery (ULMCA) disease occurs in 5–7% of patients undergoing CAG and is treated medically has a 3-year mortality rate of 50%.
2. Studies have shown PCI with drug-eluting stents for ULMCA disease can achieve low rates of death, MI, and TLR at 12 months compared to bare-metal stents which had high rates of restenosis and mortality.
3. While CABG remains the standard of care for many patients, randomized trials found PCI with DES to have non-inferior outcomes to CABG at 1-2 years for death, MI, and stroke in selected patients with low complexity lesions. Rates
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It begins by outlining the history of angioplasty and guidewire development. It then covers the purpose, components, classifications, and appropriate uses of guidewires. The main components include the core, tip, coils, covers, and coatings. Guidewires are classified based on flexibility, device support, and clinical usage. Complications like vessel perforation, pseudolesions, and entrapment are also discussed. Proper guidewire manipulation and strategies for difficult lesions are outlined to maximize safety and efficacy.
This document discusses techniques for recanalizing chronic total occlusions (CTOs). It defines a CTO and explains their etiology. Successful recanalization is associated with improved angina and reduced ischemia. Key steps include careful pre-procedure planning, selecting appropriate guidewires and microcatheters, and using techniques like parallel wiring or penetration when standard wiring fails. Expertise is important for high success rates. Proper wire shaping and handling can help avoid subintimal tracking.
percutaneous therapies for mitral regurgitationRavi Kanth
This document discusses mitral regurgitation (MR) and percutaneous approaches to mitral valve repair. It provides background on the anatomy of the mitral valve and the types of MR. Surgical repair or replacement is the standard treatment for MR but percutaneous options are being developed to provide less invasive alternatives for high-risk patients. The MitraClip procedure has been used successfully in humans and involves deploying a clip to grasp and oppose the mitral valve leaflets, reducing regurgitation. Indications, outcomes, limitations, and components of the MitraClip system are described.
This document discusses vascular closure devices (VCDs) that are used to achieve hemostasis after a cardiac catheterization procedure. It covers:
- The goals of VCDs including reducing time to hemostasis, bleeding, and allowing early patient ambulation.
- Types of VCDs including passive devices that augment natural clotting and active devices that mechanically close the artery.
- Examples of specific passive and active devices like Angioseal, Exoseal, and Manta.
- Studies showing VCDs reduce time to hemostasis and ambulation compared to manual compression.
- Tips for proper use of VCDs and potential complications.
The STITCH trial evaluated the effect of CABG plus optimal medical therapy (OMT) versus OMT alone on mortality in patients with left ventricular dysfunction and coronary artery disease. A sub-study examined the role of assessing myocardial viability to identify patients who benefit most from CABG. Of 601 patients who underwent viability testing, 487 had viable myocardium and 114 did not. There was no significant interaction between viability status and treatment assignment on mortality or other outcomes. Assessing viability did not identify patients with differential survival benefit from CABG versus OMT alone.
The document discusses various stenting strategies for treating coronary bifurcation lesions, including newer advancements. It summarizes findings on stent thrombosis and major adverse cardiac event rates from randomized trials comparing one-stent versus two-stent approaches. It also outlines techniques for provisional stenting, elective double stenting, crush and sleeve methods, and left main coronary artery bifurcation stenting. Potential issues and solutions with crush techniques are described.
This document discusses aortic interventions including aortography, balloon angioplasty, stenting, and endovascular aortic repair (EVAR). It provides indications and contraindications for aortography. It describes techniques for balloon angioplasty and stenting for conditions like aortic stenosis and coarctation of the aorta. It discusses endovascular stent grafting for treating aortic aneurysms, dissections, and ulcers. Key considerations for EVAR include assessing aortic neck length, diameter, angle, and iliac artery dimensions to determine suitability. EVAR aims to redirect blood flow by covering the primary entry tear with a stent graft.
The document discusses Abbott's bioabsorbable everolimus-eluting stent and its potential advantages over drug-eluting stents. It proposes a clinical trial to test the bioabsorbable stent in diabetic patients to demonstrate improved safety and efficacy compared to drug-eluting stents in a high risk population. Quantitative analyses estimate the cost-effectiveness and return on investment of the bioabsorbable stent if thrombosis and revascularization rates are reduced compared to drug-eluting stents.
This document summarizes coronary stents, including their purpose, types, history, procedure for placement, and future advancements. Stents are small mesh devices that are placed in arteries to keep them open and improve blood flow after balloon angioplasty. There are bare metal stents and drug-eluting stents, which combat re-narrowing after placement. The first coronary stent was placed in 1986, and drug-eluting stents were introduced in 2001 to further reduce re-narrowing. Placement involves threading a catheter through an artery to the blockage and expanding a balloon and stent to open the artery. Future advancements include bioresorbable polymers that dissolve after artery healing is complete.
interventional cardiology, Guiding catheters, wires, and balloons equipment...salman habeeb
This document provides an overview of guiding catheters, guide wires, and balloons which are core equipment used in percutaneous coronary interventions (PCI). It describes the design characteristics, advantages, and disadvantages of over-the-wire and rapid exchange balloon catheters. Key attributes of balloons like entry, tracking, and compliance are defined. Guiding catheters are discussed in terms of size, shape, and selection for accessing different coronary arteries. Finally, guide wire features such as core material, coating, and tip design are reviewed alongside common wire types used in various clinical scenarios.
Distal balloon occlusion devices and distal filter devices are the main types of embolic protection devices (EPDs) used during percutaneous coronary intervention (PCI). Distal balloon occlusion devices use a balloon to occlude blood flow distal to the lesion during PCI, while distal filter devices use a nitinol mesh filter to capture debris without interrupting blood flow. Major trials have shown the benefits of EPDs for saphenous vein graft interventions and for STEMI patients undergoing PCI. EPD selection depends on lesion location and vessel characteristics. EPDs are recommended for saphenous vein graft PCI but their routine use is not supported for native coronary artery PCI.
I. A coronary stent is a mesh tube placed in arteries to treat heart disease and keep arteries open. It is implanted via angioplasty.
II. Stents are implanted by threading a balloon catheter into the heart and inflating the balloon to expand the stent against the artery wall.
III. While generally safe, potential risks of stents include blood clots, infection, and re-narrowing of the artery known as restenosis.
How to deal with CALCIFIED CORONARY ARTERY LESIONS .Coronary artery calcification (CAC) is highly prevalent in patients with coronary heart disease (CHD) and is associated with major adverse cardiovascular events. There are two recognized type of CAC—intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary intervention have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD patients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.
The document summarizes the expanding clinical applications of endovascular aneurysm repair (TEVAR) beyond its original use for descending thoracic aneurysms. It discusses how TEVAR is now being used to treat a wider range of thoracic aortic pathologies including dissections, ulcers, trauma, and various complex aneurysms. The document also explores new techniques like branched endografts and debranching procedures that are pushing the anatomic limits of TEVAR proximally and distally. While noting some limitations, it presents data showing TEVAR has led to reduced mortality, complications, and hospital stay compared to open surgery for many thoracic aortic conditions.
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
This document discusses chronic total occlusion (CTO) of coronary arteries. It defines CTO and differentiates it from functional occlusions and pseudo-occlusions. The prevalence of CTO is estimated to be around 15% based on registry data. CTOs present technical challenges for percutaneous coronary intervention (PCI) due to factors like lesion length, calcification, and tortuosity. Proper preparation is important for CTO PCI, including adequate guide support and anticoagulation. Scoring systems can help predict the difficulty of crossing a CTO. Special guidewires and techniques may be needed depending on the lesion characteristics and collateral pathways.
This document discusses different techniques for percutaneous coronary intervention (PCI) of bifurcation lesions. It begins by defining a bifurcation lesion and classifying them using the Medina classification system. It then describes commonly used PCI strategies such as provisional stenting, crush, culotte, T stenting, and kissing stents. Several studies comparing outcomes of single versus two stent techniques and crush versus culotte are summarized. The document concludes by emphasizing keeping PCI procedures for bifurcation lesions safe, simple and swift.
Guide catheters in coronary interventionRohitWalse2
Guide catheters are essential for coronary interventions as they deliver hardware into the arteries. The document discusses the properties and types of guide catheters, highlighting how their structure provides support and torque control. It describes commonly used guide catheters like the Judkins, Amplatz and EBU catheters, noting what vessels each is best suited for. Specialty guide catheters for difficult anatomies are also reviewed. Proper guide selection and positioning are emphasized for coaxial engagement and optimal device delivery during interventions.
TAVR SAVR evolution of a groundbreaking therapyLuisArturo RV
TAVR has evolved from its first human implantation in 2002 to becoming a standard treatment for aortic stenosis. Pivotal clinical trials showed TAVR was superior to medical management for inoperable patients and non-inferior to SAVR for high-risk patients. Later trials found TAVR non-inferior to SAVR for intermediate-risk patients. The latest PARTNER 3 and Evolut trials found TAVR non-inferior and even superior to SAVR for low-risk patients, with lower rates of rehospitalization, stroke, and better functional improvement. Ongoing developments aim to reduce vascular complications, permanent pacemaker rates, and expand TAVR to younger patients. T
1. Significant unprotected left main coronary artery (ULMCA) disease occurs in 5–7% of patients undergoing CAG and is treated medically has a 3-year mortality rate of 50%.
2. Studies have shown PCI with drug-eluting stents for ULMCA disease can achieve low rates of death, MI, and TLR at 12 months compared to bare-metal stents which had high rates of restenosis and mortality.
3. While CABG remains the standard of care for many patients, randomized trials found PCI with DES to have non-inferior outcomes to CABG at 1-2 years for death, MI, and stroke in selected patients with low complexity lesions. Rates
This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It begins by outlining the history of angioplasty and guidewire development. It then covers the purpose, components, classifications, and appropriate uses of guidewires. The main components include the core, tip, coils, covers, and coatings. Guidewires are classified based on flexibility, device support, and clinical usage. Complications like vessel perforation, pseudolesions, and entrapment are also discussed. Proper guidewire manipulation and strategies for difficult lesions are outlined to maximize safety and efficacy.
This document discusses techniques for recanalizing chronic total occlusions (CTOs). It defines a CTO and explains their etiology. Successful recanalization is associated with improved angina and reduced ischemia. Key steps include careful pre-procedure planning, selecting appropriate guidewires and microcatheters, and using techniques like parallel wiring or penetration when standard wiring fails. Expertise is important for high success rates. Proper wire shaping and handling can help avoid subintimal tracking.
percutaneous therapies for mitral regurgitationRavi Kanth
This document discusses mitral regurgitation (MR) and percutaneous approaches to mitral valve repair. It provides background on the anatomy of the mitral valve and the types of MR. Surgical repair or replacement is the standard treatment for MR but percutaneous options are being developed to provide less invasive alternatives for high-risk patients. The MitraClip procedure has been used successfully in humans and involves deploying a clip to grasp and oppose the mitral valve leaflets, reducing regurgitation. Indications, outcomes, limitations, and components of the MitraClip system are described.
This document discusses vascular closure devices (VCDs) that are used to achieve hemostasis after a cardiac catheterization procedure. It covers:
- The goals of VCDs including reducing time to hemostasis, bleeding, and allowing early patient ambulation.
- Types of VCDs including passive devices that augment natural clotting and active devices that mechanically close the artery.
- Examples of specific passive and active devices like Angioseal, Exoseal, and Manta.
- Studies showing VCDs reduce time to hemostasis and ambulation compared to manual compression.
- Tips for proper use of VCDs and potential complications.
The STITCH trial evaluated the effect of CABG plus optimal medical therapy (OMT) versus OMT alone on mortality in patients with left ventricular dysfunction and coronary artery disease. A sub-study examined the role of assessing myocardial viability to identify patients who benefit most from CABG. Of 601 patients who underwent viability testing, 487 had viable myocardium and 114 did not. There was no significant interaction between viability status and treatment assignment on mortality or other outcomes. Assessing viability did not identify patients with differential survival benefit from CABG versus OMT alone.
The document discusses various stenting strategies for treating coronary bifurcation lesions, including newer advancements. It summarizes findings on stent thrombosis and major adverse cardiac event rates from randomized trials comparing one-stent versus two-stent approaches. It also outlines techniques for provisional stenting, elective double stenting, crush and sleeve methods, and left main coronary artery bifurcation stenting. Potential issues and solutions with crush techniques are described.
This document discusses aortic interventions including aortography, balloon angioplasty, stenting, and endovascular aortic repair (EVAR). It provides indications and contraindications for aortography. It describes techniques for balloon angioplasty and stenting for conditions like aortic stenosis and coarctation of the aorta. It discusses endovascular stent grafting for treating aortic aneurysms, dissections, and ulcers. Key considerations for EVAR include assessing aortic neck length, diameter, angle, and iliac artery dimensions to determine suitability. EVAR aims to redirect blood flow by covering the primary entry tear with a stent graft.
The document discusses Abbott's bioabsorbable everolimus-eluting stent and its potential advantages over drug-eluting stents. It proposes a clinical trial to test the bioabsorbable stent in diabetic patients to demonstrate improved safety and efficacy compared to drug-eluting stents in a high risk population. Quantitative analyses estimate the cost-effectiveness and return on investment of the bioabsorbable stent if thrombosis and revascularization rates are reduced compared to drug-eluting stents.
This document summarizes coronary stents, including their purpose, types, history, procedure for placement, and future advancements. Stents are small mesh devices that are placed in arteries to keep them open and improve blood flow after balloon angioplasty. There are bare metal stents and drug-eluting stents, which combat re-narrowing after placement. The first coronary stent was placed in 1986, and drug-eluting stents were introduced in 2001 to further reduce re-narrowing. Placement involves threading a catheter through an artery to the blockage and expanding a balloon and stent to open the artery. Future advancements include bioresorbable polymers that dissolve after artery healing is complete.
Drug-eluting stents (DES) are coronary stents that slowly release drugs to prevent restenosis. Restenosis occurs when scar tissue blocks the stented artery. Clinical trials showed DES have lower rates of major adverse cardiac events compared to bare-metal stents. Challenges in packaging DES include maintaining drug stability and effectiveness while allowing sterilization and providing a sterile barrier until use. Proper packaging is crucial given the high cost of DES.
This document summarizes the current status of bioresorbable scaffolds for treating coronary artery disease. It describes the materials used in bioresorbable scaffolds like PLLA and magnesium, as well as some of the first bioresorbable scaffolds developed. Potential benefits of bioresorbable scaffolds include reduced risk of thrombosis, less inflammation, and restoration of vasomotion. However, limitations remain such as lack of large randomized trials and limited scaffold sizes currently available. While bioresorbable scaffolds show advantages over permanent stents, more evidence is still needed before widespread adoption.
Innovation trends and Opportunities in safety critical coronary artery stentsRamanan Lakshminarayanan
A presentation that is intended for Researchers for giving an overview of Coronary Stents, Its importance to mankind, its deployment procedure and modality and the the opportunities for Research and Innovation
1) The document discusses the history and evolution of biovascular scaffolds, from plain old balloon angioplasty to bare metal stents to drug-eluting stents.
2) It describes the potential advantages of bioabsorbable vascular scaffolds (BVS) compared to permanent stents, including restoration of vascular function and no need for long-term antiplatelet therapy.
3) Several types of BVS are presented, including those made of polylactic acid, magnesium alloys, and polyanhydrides, along with results from early clinical trials testing safety and performance.
Bioabsorbable stents are manufactured from materials that dissolve in the body over time. They serve the same purpose as traditional metal stents by expanding a blocked blood vessel, but eventually degrade so the vessel is freed from the scaffold. Polymer-based materials like PLLA and absorbable metals such as magnesium alloys are being tested. Bioabsorbable stents could overcome limitations of permanent metal stents by eliminating risk of late thrombosis and local inflammation once dissolved. Several types are currently in clinical trials and projected to gain significant market share as they receive FDA approval.
This document summarizes postmarketing studies comparing the Russian-made Calypso drug-eluting stent to analogous foreign stents. It describes two ongoing comparative registry studies - E-Calypso and Patriot - that are evaluating the safety and efficacy of the Calypso stent versus competitors like the Resolute Integrity and Xience Prime stents. The document outlines the study designs, endpoints, inclusion/exclusion criteria and administrative details of the comparative studies which are taking place in Russia through 2016. It also provides technical specifications and performance data indicating the Calypso stent is competitive with leading foreign stents while offering significant cost savings.
This document discusses biodegradable coronary stents and future solutions. It notes that metal stents have drawbacks like permanent irritation and inability to restore normal vessel physiology. Biodegradable stents aim to eliminate these issues by degrading over time and allowing the vessel to heal. Design considerations for biodegradable stents include degradation rate, biocompatibility, mechanical properties, and drug loading. Examples of biodegradable stents discussed include the Igaki-Tamai stent, Abbott's everolimus-eluting stent, and REVA's paclitaxel-eluting stent. New concepts discussed are pro-healing stents coated with endothelial progenitor cells and drug-eluting ballo
This document discusses the stability testing of drug-eluting stents. It outlines Conor's reservoir technology where the drug is formulated with a bio-resorbable polymer and deposited in wells on the stent struts. Tests discussed for ensuring stability include assays to measure drug content, identification and quantification of impurities and degradation products, in vitro drug release kinetics, polymer molecular weight and content, residual solvents, and particulate matter. The document recommends a stability protocol that includes testing samples from multiple batches at various time points under long-term and accelerated conditions to establish a shelf life for the drug-eluting stents.
In-Stent Restenosis occurs when a blockage redevelops inside a stent placed in a coronary artery. The rate of restenosis is lower with drug-eluting stents (DES) compared to bare-metal stents or balloon angioplasty alone. For treatment of in-stent restenosis, repeat stenting with DES has shown success, though DES for prior DES restenosis remains controversial due to the risk of developing multiple layers of stent struts. Drug-coated balloons are an alternative to repeat stenting and have been shown to be effective for both bare-metal and drug-eluting stent in-stent restenosis. Ongoing randomized clinical trials are further evaluating
Problem associated with drug eluting stentPRAVEEN GUPTA
This ppt will tell us about the problem which a cardiologist has to face after implantation of Drug eluting stent in a patient of coronary artery diseases. Although there are lots of problem but i am going to describe only three major problem.
This document summarizes the history of innovation and technology in San Antonio from the 17th century to present day. It discusses how San Antonio became a center for missions, irrigation systems, aviation, space exploration, cybersecurity and more. Key innovations that originated in San Antonio include some of the first personal computers, WiFi technology, and large-scale virtual worlds for learning. The document argues that San Antonio's history positions it as an innovative city of the future.
Mission: Lifeline® STEMI and Cardiac Resuscitation Systems of Care Launch (we...David Hiltz
CREATING STEMI AND CARDIAC RESUSCITATION SYSTEMS OF CARE AND IMPROVING EXISTING ONES.
Each year, more than half a million Americans experience ST-elevation myocardial infarction (STEMI), out-of-hospital cardiac arrest or both. The majority of these patients fail to receive appropriate treatment for their life-threatening conditions within recommended timeframes.
Mission: Lifeline® was created by the American Heart Association as a response to missed opportunities for prompt, appropriate STEMI treatment. Recently, Mission: Lifeline expanded to help existing STEMI systems of care incorporate out-of-hospital cardiac resuscitation into their systems.
Cardiac resuscitation can make a lifesaving difference.
Seventy percent of out-of-hospital cardiac arrest patients have identified coronary vascular disease, and 50 percent have STEMI.
Without prompt cardiac resuscitation, many of the STEMI patients who could potentially benefit from a coordinated STEMI system of care might not survive long enough to enter the system.
That makes cardiac resuscitation a vital component in STEMI systems of care, as well as a key intervention across the full spectrum of out-of-hospital cardiac arrest. For that reason, Mission: Lifeline® now offers established STEMI systems of care the opportunity to incorporate cardiac resuscitation.
- Platelets play an important role in blood clotting by clumping together to form blood clots, which stop bleeding from cuts or wounds. However, blood clots inside arteries can block blood flow and damage tissues.
- Antiplatelet drugs like aspirin work by preventing platelets from clumping together. Aspirin is commonly used after CABG surgery and procedures like angioplasty to prevent new blood clots from forming and reduce the risk of future heart attacks.
- While aspirin is generally safe, concerns remain about how soon after surgery it can safely be given to balance preventing clots versus risks of bleeding complications. Studies found low dose aspirin given within 48 hours of CABG was not
Global interventional cardiology market 2017-2022 sample reportNetscribes, Inc.
Interventional cardiology is the catheter-based treatment of cardiovascular diseases. Certified cardiologists who perform these procedures are known as intervention cardiologists.
https://www.researchonglobalmarkets.com/global-interventional-cardiology-market-2014-2022.html
For the full report please write to info@netscribes.com
History of device development: Past, Present, Future History of device deve...MedicineAndFamily
The document discusses the history and future of device development in interventional cardiology. It covers major milestones from 1977 to the present in areas like coronary angioplasty, stenting, treatment of carotid artery stenosis, and percutaneous valve therapies. The document also discusses different funding approaches for startups and challenges in areas like bifurcation lesions, chronic total occlusions, and the potential for biodegradable stents and other future opportunities in the field.
Intravascular lithotripsy (ivl) for peripheral arterial diseaseRamachandra Barik
There are a number of observations that suggest IVL produces
compliance changes in the vessel wall:Effacement of calcified stenoses with lithotripsy at low pressure with no change in angioplasty balloon pressure •Changes in echotexture on Duplex Ultrasound•Changes in appearances on Optical Coherence Tomography
Coronary bifurcation lesions are challenging to treat percutaneously and account for approximately 15% of PCIs. Interventions on bifurcations have lower success rates and higher complication rates than other lesions. The optimal strategy for treating bifurcations, whether provisional stenting of the main vessel with treatment of the side branch only if needed versus systematic two-stent techniques, is still debated. Several randomized trials have compared different approaches but longer-term data is still needed. Dedicated bifurcation stents may improve outcomes but need low profiles, ease of use, and cost effectiveness.
A 56-year-old male with a history of heart disease presented with ongoing chest pain after an unsuccessful attempt to open a chronic total occlusion of the right coronary artery via percutaneous coronary intervention 6 weeks prior. The patient underwent a second PCI procedure where the CTO was successfully opened using an antegrade approach, resolving his symptoms. At follow-ups 6 months, 12 months and 18 months later, the patient reported continued relief from symptoms and was able to return to exercising and training for triathlons without any chest pain.
РАДИОЛОГИЯ: журнал British Journal of Radiology - British Institute of Radiol...oncoportal.net
This document summarizes the key topics discussed at the 2005 President's Conference on "Technology in Imaging and Radiotherapy". The conference highlighted advances in medical imaging technologies like CT and their impact on clinical practice and workflow. Presentations covered improvements in CT scanner design allowing faster, lower dose scans over wider areas. Applications of newer cardiac CT and particle therapy techniques were also discussed. The conference emphasized that while technology enables better outcomes, optimized implementation through improved workflows is also needed to increase productivity and efficiency in medicine.
This document provides an overview of Kips Bay Medical, Inc. and its eSVS Mesh technology. Kips Bay Medical was founded by Manny Villafaña, who has a history of founding successful medical device companies. The eSVS Mesh is designed to support saphenous vein grafts used in coronary artery bypass grafting surgery to improve graft longevity. The company has received CE Mark approval and is conducting a clinical trial for FDA approval in the US. If approved, the eSVS Mesh could address a large market opportunity and build on the founder's track record of creating value in the cardiac device field.
A sample of my pitch-deck writing and related market research for a revolutionary and next-generation micro cardiovascular stent, which incorporates nanotechnology, MEMS, computer controlled surgery algorithms, and MRI. I conducted this work for a client, an inventor and scientist who gave me permission to make this sample public.
A Review of Atherectomy in Peripheral Arterial Diseaseasclepiuspdfs
Atherectomy involves exciting technology and offers expanded treatment options for PAD. Data are scant so far in most lower extremity territories to support its use over other interventions, but newer results are promising. There is still a financial benefit to choosing atherectomy in the outpatient setting that likely drives much of its popularity among interventionalists. Atherectomy is an exciting technology for peripheral vascular intervention. Its use has greatly increased over the last decade. Data on its superiority to angioplasty or angioplasty with stenting are scant. Here, we review atherectomy techniques and principles along with results and controversy surrounding its use.
1. Successful PCI of chronic total occlusions (CTO) is associated with improved symptoms, increased exercise capacity, reduced need for CABG, and survival benefit compared to failed CTO PCI based on observational studies.
2. Randomized trials are still needed to provide high-level evidence on the benefits of CTO PCI given limitations of observational data though several large randomized trials are underway.
3. Expert operators can now achieve high success rates of over 90% for CTO PCI with low complication rates even for complex CTOs, using bilateral injections, IVUS, retrograde approaches and specialized guidewires and catheters.
Grand Rounds: Univ of Chicago CardiologyRobert Poston
This document discusses marketing strategies for less invasive cardiac surgery techniques like robotic CABG. It notes that patients generally prefer less invasive procedures due to quicker recovery times. The document outlines tactics for marketing robotic CABG such as developing websites, publications, presentations and advertising. It acknowledges both benefits like improved cosmesis but also challenges like higher costs and learning curves. Data on early ad campaigns for robotic CABG show they increased elective case volume and reduced length of stay. The document emphasizes integrating marketing messages and reassessing based on the local environment.
This document provides an overview and market analysis of the neurointerventional devices market from 2010 to 2017. It states that the global market was estimated at $1.25 billion in 2012 and is expected to grow at a 6.8% compound annual growth rate to $1.73 billion by 2017. The largest segment is aneurysm coiling and arteriovenous malformation embolization and fistula embolization. North America currently dominates the market but Asia-Pacific and Latin America are expected to grow faster due to increasing healthcare spending. The report covers market drivers, trends, competitive landscape and company profiles of major players.
Chronic Total Occlusions: The Road Less TraveledAllina Health
By M. Nicholas Burke, MD. The use of pioneering percutaneous treatments for chronic total occlusions: indications, limitations, outcomes and current research.
Kambis Masheyekhi: Optimal planning of CTO-PCIEuro CTO Club
14th Experts Live CTO
September 2nd - 3rd, 2022 - Mainz, Germany
AGIK Parallel Session - Session 1:
The 101 of the global consensus approaches
Optimal planning of CTO-PCI
Kambis Masheyekhi, Lahr, Germany
Room:
West Foyer - Friday 10:10
Chairmen:
Thomas Schmitz, Essen, Germany;
Heinz Joachim Büttner, Bad Krozingen, Germany
Innovations in Percutaneous Intervention, 1977-2007. Slides created by Simon H. Stertzer, MD, FACC, FAHA, Professor Emeritus, Stanford University School of Medicine.
mode of failures in Hip and Knee Replacement.pptSuguKumar14
Total hip and knee replacement are highly successful operations, but implant failures do occur. When failures happen, the type and cause of failure determines the revision procedure needed. Current medical codes do not provide details on the cause of implant failures. Revised codes could help track outcomes, complications for different implants, and identify issues earlier to improve joint replacement procedures and reduce revisions.
Rotational atherectomy may provide benefits over plain balloon angioplasty for treating severely calcified coronary lesions. It allows for more effective preparation and debulking of hard plaque, enabling better stent expansion and apposition. However, studies comparing rotational atherectomy plus drug-eluting stent versus plain angioplasty plus drug-eluting stent have shown inconsistent results, with no clear evidence that rotational atherectomy improves long-term outcomes in the drug-eluting stent era. Further research is still needed to determine whether current generation drug-eluting stents achieve similar results with or without preceding rotational atherectomy for complex lesion subsets.
Ở BẸNH NHÂN NGUY CƠ CAO CÁC CẢI TIẾN VỀ CÔNG NGHỆ VÀ THUỐC CÓ GIÚP CÁC STENT ...SoM
- The document discusses stent technology evolution and whether newer-generation drug-eluting stents (DES) with different coatings are better for high-risk patients.
- Newer DES with durable polymers have improved safety outcomes compared to older DES and bare-metal stents, but are still associated with higher failure rates in high-risk patients.
- Biodegradable polymer DES like the Orsiro stent aim to reduce inflammation and promote healing to improve long-term outcomes over durable polymer DES for high-risk groups. Clinical trials show the Orsiro stent has comparable safety and efficacy to the best durable polymer DES.
The global interventional cardiology and peripheral vascular devices market was valued at $8.7 billion in 2011 and is expected to grow to $12.7 billion by 2016. The market consists of devices used in coronary and peripheral endovascular procedures. Major drivers of growth include increasing demand for minimally invasive treatments and rising rates of coronary and peripheral artery diseases. North America currently dominates the market but Asia is growing the fastest.
Below the knee intervention; balloons or stentsMohamed Ashraf
This document discusses endovascular interventions for below-the-knee peripheral artery disease. It reviews the use of plain balloon angioplasty, bare-metal stents, drug-eluting stents, and drug-coated balloons. While balloon angioplasty alone has high restenosis rates, bare-metal stents provide improved outcomes but drug-eluting stents have been shown to further reduce restenosis and reintervention rates compared to bare-metal stents. Drug-coated balloons have potential benefits but large clinical trials have produced mixed results regarding their efficacy compared to plain balloon angioplasty. The optimal treatment remains an area of ongoing investigation.
Similar to MT5007: The coronary stent revolution (A group project for the Management of Technology Innovation module) (20)
Business Case Study: Avatar Coronary Stents for IndonesiaStefan
I did this introductory course on managing and commercialising current innovations in BioTechnology in 2010.
*This project preceded development in depth technology strategies coronary stent innovations.
'Tuned Inside-Out': Mediating engagement experiences with music on-the-go"Stefan
PhD Confirmation Seminar: Jun Quan Choo (Stefan)
Date: Friday the 9th of March
Time: 10.00 am- 11.30 am
Venue: GP-V713
Lengthy commute stresses commuters with adverse impacts on their wellbeing. During these experiences, commuters engage with music via portable music technologies, like headphones plugged into iPods. Engaging with music affords listeners distraction from the stresses of commute, for pleasure and other reasons. Empirical evidence suggests classical music is effective in mitigating stresses, and people use music as a wellbeing resource. These studies were based on a listener’s mental representation of music. Instead, a listener’s engagement with music is more than a mental representation in real life; music moves people. There are no available significant studies of how people embody interactions with music via portable music devices in accordance to his needs. To address the gap, this research investigates
what shapes a commuter’s engagement with music as they commute via trains in a major Australian metropolitan city and the involvement of technologies in mediating the commuter’s
interactions with music in context. An experiment involving video-recorded observations will capture individual participating commuter’s movements and physiological reactions in engagement with music devices ranging from headphones to haptic devices and Virtual Reality headsets. Retrospective interviews probe the participant’s association of movements in his music experience. Thematic analyses of participants’ bodily use of senses and movements, how these relate to their music experiences and wellbeing will be distilled into design recommendations. It is expected that these recommendations can inform technology providers, music producers, musicians and railway operators possibilities to adapt or design portable music technologies appropriate for commuters’ use in context.
Opportunities and challenges in Laryngeal Microsurgery- A graduate seminar pr...Stefan
This document summarizes a presentation on opportunities and challenges in laryngeal microsurgery. It introduces vocal fold pathology and interventions like excision of lesions. It discusses the setup for microlaryngeal surgery on pigs and patients. Experimental task analysis found that a single microclip provided superior holding strength to resist low strains compared to a suture. Microclips were also faster to deploy than sutures. Further investigation of microclip mechanical properties at low strains over time was recommended. The document suggests microclips have potential as alternatives for wound closure in situations with minimal displacement and could be customized and quickly deployed, representing disruptive innovation compared to sutures.
Case study: Understanding Human Factors and Materials in selection of Slitter...Stefan
This document provides an overview of different slitting technologies used to cut materials into strips, including razor slitting, crush/score slitting, and shear slitting. It compares the key factors to consider for each technology and how to match the appropriate slitting method to the material properties. The document emphasizes that selecting the right slitting method for the specific material and desired cut is most important. It also discusses technology value chains for slitting suppliers and opportunities for innovation.
Where lies the Innovator's Advantage in strategic sourcing?Stefan
Traditional operational and supply chain operations are often driven by speed, efficiency and cost reductions for large businesses to thrive on operations leverage. Products or services provided by suppliers and contract manufacturers are frequently normalized in prices and benchmarked against commodity prices. Sourcing/ purchasing functions often strive to engage and develop meaningful relationships with tried, tested and proven suppliers to meet the matching drivers of supply chain operations. Sourcing thrives on generating competitiveness amongst suppliers that enables the strategic negotiation of price- value reductions; the larger the pool of matching suppliers, the better the bargaining power of sourcing.
However, with increasing labor and wage costs of manufacturing in domestic markets, many suppliers of traditionally manufactured products have relocated their manufacturing operations to China to keep operating margins low. A shift in the competitive architecture is recommended for sourcing operations to access new areas of innovation. Exploratory frameworks for synthesizing innovation through suppliers include (1) Core-competence and R&D networks of the outsource supplier (2) Enabling design centricity of supplier’s products to target consumer profiles (3) Suppliers with new materials/ methods wanting to break into local markets, with a potential disruptive impact.
MT5004- Seat hogging misbehaviours on passenger trains in Singapore- root ca...Stefan
A seven-step framework applied to emphasise, understand and map the mental models passengers who abuse the priority seats on SMRT trains in Singapore. Data gathering methods ranging from ethnography to persona modelling were employed in this study. The group ideated prototypes and campaigns that target to eliminate or reduce behavioural triggers attributed to seat-hogging.
GS6887A: Applying Musical Expectation- Perception and Interpretation (Individ...Stefan
This document discusses musical expectation from a knowledge management perspective. It describes how listeners implicitly gain tacit musical knowledge through experiences that integrate explicit data and theories. Musical expectations involve perceiving patterns in pitch, meter, tempo, density and being surprised by deviations from these patterns. The document also discusses how musical prosody, or expressive nuances in performance, can enhance or violate expectations and elicit emotional responses like chills or tears. It provides examples of how Stravinsky's Rite of Spring defied expectations by using unusual harmonies and structures.
Tata Group Dials Taiwan for Its Chipmaking Ambition in Gujarat’s DholeraAvirahi City Dholera
The Tata Group, a titan of Indian industry, is making waves with its advanced talks with Taiwanese chipmakers Powerchip Semiconductor Manufacturing Corporation (PSMC) and UMC Group. The goal? Establishing a cutting-edge semiconductor fabrication unit (fab) in Dholera, Gujarat. This isn’t just any project; it’s a potential game changer for India’s chipmaking aspirations and a boon for investors seeking promising residential projects in dholera sir.
Visit : https://www.avirahi.com/blog/tata-group-dials-taiwan-for-its-chipmaking-ambition-in-gujarats-dholera/
At Techbox Square, in Singapore, we're not just creative web designers and developers, we're the driving force behind your brand identity. Contact us today.
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Discover timeless style with the 2022 Vintage Roman Numerals Men's Ring. Crafted from premium stainless steel, this 6mm wide ring embodies elegance and durability. Perfect as a gift, it seamlessly blends classic Roman numeral detailing with modern sophistication, making it an ideal accessory for any occasion.
https://rb.gy/usj1a2
buy old yahoo accounts buy yahoo accountsSusan Laney
As a business owner, I understand the importance of having a strong online presence and leveraging various digital platforms to reach and engage with your target audience. One often overlooked yet highly valuable asset in this regard is the humble Yahoo account. While many may perceive Yahoo as a relic of the past, the truth is that these accounts still hold immense potential for businesses of all sizes.
Building Your Employer Brand with Social MediaLuanWise
Presented at The Global HR Summit, 6th June 2024
In this keynote, Luan Wise will provide invaluable insights to elevate your employer brand on social media platforms including LinkedIn, Facebook, Instagram, X (formerly Twitter) and TikTok. You'll learn how compelling content can authentically showcase your company culture, values, and employee experiences to support your talent acquisition and retention objectives. Additionally, you'll understand the power of employee advocacy to amplify reach and engagement – helping to position your organization as an employer of choice in today's competitive talent landscape.
Understanding User Needs and Satisfying ThemAggregage
https://www.productmanagementtoday.com/frs/26903918/understanding-user-needs-and-satisfying-them
We know we want to create products which our customers find to be valuable. Whether we label it as customer-centric or product-led depends on how long we've been doing product management. There are three challenges we face when doing this. The obvious challenge is figuring out what our users need; the non-obvious challenges are in creating a shared understanding of those needs and in sensing if what we're doing is meeting those needs.
In this webinar, we won't focus on the research methods for discovering user-needs. We will focus on synthesis of the needs we discover, communication and alignment tools, and how we operationalize addressing those needs.
Industry expert Scott Sehlhorst will:
• Introduce a taxonomy for user goals with real world examples
• Present the Onion Diagram, a tool for contextualizing task-level goals
• Illustrate how customer journey maps capture activity-level and task-level goals
• Demonstrate the best approach to selection and prioritization of user-goals to address
• Highlight the crucial benchmarks, observable changes, in ensuring fulfillment of customer needs
Company Valuation webinar series - Tuesday, 4 June 2024FelixPerez547899
This session provided an update as to the latest valuation data in the UK and then delved into a discussion on the upcoming election and the impacts on valuation. We finished, as always with a Q&A
Industrial Tech SW: Category Renewal and CreationChristian Dahlen
Every industrial revolution has created a new set of categories and a new set of players.
Multiple new technologies have emerged, but Samsara and C3.ai are only two companies which have gone public so far.
Manufacturing startups constitute the largest pipeline share of unicorns and IPO candidates in the SF Bay Area, and software startups dominate in Germany.
Navigating the world of forex trading can be challenging, especially for beginners. To help you make an informed decision, we have comprehensively compared the best forex brokers in India for 2024. This article, reviewed by Top Forex Brokers Review, will cover featured award winners, the best forex brokers, featured offers, the best copy trading platforms, the best forex brokers for beginners, the best MetaTrader brokers, and recently updated reviews. We will focus on FP Markets, Black Bull, EightCap, IC Markets, and Octa.
Unveiling the Dynamic Personalities, Key Dates, and Horoscope Insights: Gemin...my Pandit
Explore the fascinating world of the Gemini Zodiac Sign. Discover the unique personality traits, key dates, and horoscope insights of Gemini individuals. Learn how their sociable, communicative nature and boundless curiosity make them the dynamic explorers of the zodiac. Dive into the duality of the Gemini sign and understand their intellectual and adventurous spirit.
Implicitly or explicitly all competing businesses employ a strategy to select a mix
of marketing resources. Formulating such competitive strategies fundamentally
involves recognizing relationships between elements of the marketing mix (e.g.,
price and product quality), as well as assessing competitive and market conditions
(i.e., industry structure in the language of economics).
The 10 Most Influential Leaders Guiding Corporate Evolution, 2024.pdfthesiliconleaders
In the recent edition, The 10 Most Influential Leaders Guiding Corporate Evolution, 2024, The Silicon Leaders magazine gladly features Dejan Štancer, President of the Global Chamber of Business Leaders (GCBL), along with other leaders.
2. SNAPS Group Members
Chan Kah Inn, Darryl
Choo Jun Quan, Stefan
Bjorn Mattias Lindfors
Phua Geok Bee (PanYumei)
Tan Chye Huat
Tang Shu Ling
Soon Yew Boon
3. Presentation Outline
Introduction to Coronary Artery Disease
Evolution of Technologies for disease treatment
PTCA as Disruptive Technology to CABG
Coronary Stents: BMS, DES, Bioabsorbable stents
Evolution of Stent Design
Stent Industry Overview & Market Analysis
Introduction to Abbott Vascular & SWOT analysis
Challenges & Managing the Innovation
4. What is Coronary Artery
Disease?
A type of heart disease which
occurs when the coronary
arteries become narrow due to
the build-up of fatty deposits
called plaques
Coronary arteries supply the
heart with oxygen and
nourishment
5. Disease Prevalence
Grim Statistics
Leading cause of death
globally
Estimated 17.3 million died in
2008
By 2030, almost 23.6 million
will die yearly
80% of deaths occur in low
and middle-income countries
Source: WHO report Global Atlas on Cardiovascular Disease Prevention
and Control, 2011
6. Distribution of Economic Wealth
Blue Circled Areas on World Map Denote
where current healthcare interventions are
focused
Strong Co-relation between
Cardiovascular Diseases and Low per
capita GDP
7. Drivers for Coronary Revascularization
Technologies Evolution
Demographics
Ageing Population
Increase of cardiovascular patients
(Lifestyle changes)
Demand for Technology
Enhance Lifestyle
Save life, Decrease pain, Improve
health
Lower morbidity and mortality rates
8. Evolution of Coronary
Revascularization Technologies
1960s
1977s
1987
Today
Coronary Artery
Bypass Grafting
(CABG)
• Invasive surgical procedure
• Arteries or veins from elsewhere
in the patient's body are grafted
to the coronary arteries
• Surgery is usually performed with
the heart stopped, necessitating
the usage of cardiopulmonary
bypass
9. Evolution of Coronary
Revascularization Technologies
1960s
Percutaneous
Transluminal Coronary
Angioplasty (PTCA)
1977s
1987
Today
• Minimally Invasive procedure
• PTCA involves only a small incision through which a
balloon-tipped catheter is threaded
• Upon reaching the point of blockage, the balloon is
inflated to restore blood flow
• However, less effective compared to CABG
• Higher revascularization rate of 21% (CAGB –
6%)
10. Performance
- Lower restenosis rate
Procedure rates
/1,000 population, age 45+
S – Curves for CABG and PTCA
•
PTCA
At the start, PTCA’ s efficacy is
below that of CABG
BUT
CABG
•
PTCA
Market demand
•
CABG
•
Time
PTCA has important key
attractions
• Minimally invasive
• Fast recovery from
procedure, short hospital
stay
• Costs less
PTCA was welcome by
patients & adopted rapidly by
cardiologists as gold standard
for CAD treatment
Incremental improvements
eventually rendered PTCA’s
performance acceptable by
main market
11. How does PTCA affect
conventional medical practice?
Disruptive in job scope of cardiologists
Need to learn new skills and techniques
Steep Learning Curve: Cardiologists
specialized in coronary intervention
Knowledge conversion
Internalization: From Explicit to Tacit
knowledge
Learning & acquiring new tacit knowledge in practice
12. Evolution of Coronary
Revascularization Technologies
1960s
1977s
1987
•
Coronary Stents
•
Today
Stents are tiny mesh tubes that are left
in coronary arteries to keep blockages
from recurring.
Stents significantly reduced post-BA
complications of restenosis
13. Evolution of Coronary
Revascularization Technologies
• The success of Stents has
subsequently bolstered it to
become the dominant design
in the coronary
revascularization industry
• Battle for the stent market
shares
1960s
1977s
1987
Stents WARS!!
Today
15. Evolution of Stents Design
Stent Prototype
(1985)
Establishment of
Stent’s Radical
Design (Early 1990s)
• Created from copper wire and solder
by Dr Julio Palmaz [Innovator]
• J & J [First Mover] – No Experience
• 1st COMMERCIALIZED Design
• Numerous Stent Designs
• Palmaz-Schatz Stent’s Construction
• Slotted Tube
• [Dominant Design]
Wallstent
Wiktor
GR Flex-Stent
Palmaz/Palmaz- Schatz
elgiloy
tantalum
stainless steel
stainless steel
Form
wire
wire
wire
tube
Fabrication
braid
bend
bend
EDM
Geometry
braid
helical rings
clamshell
slotted tube
Material
16. Evolution of Stents Design
• Flexibility = Deliverability or Contourability
• New Fabricating Technologies
• Photochemical (PC) etching --Addition of flexible connector
[Incremental Innovation]
Improvement–
Flexibility (1995) • Laser micromachining – Now preferred fabricating technique
Improvement–
Geometry
(1997)
• Open Cell / Closed Cell Stent Design
• Palmaz-Schatz stent and its successor, the “Crown” by J & J (A)
• Closed Cell = Inflexible = Not Good
• MultiLink stent by Guidant (E)
• Open Cell, Flexible = Good , Leading the Market for 5 years
17. • Breakthrough appearance of stents eluting antiproliferative drugs
• Overall reduction in restenosis rate of between 70% to 85%
Addition – Drug
Eluting Coating • Modular Innovation
18. Image obtained via World Wide Web at
http://www.art-stent.com/Images/Img-003-Big.jpg on 20 Oct 2011
Bioasorbable
stent
• Stent support vessel with minimum local tissue aggravation
• Stent serves as scaffold construct that facilitates dynamic reconstruction of
vessel tissue lining- “Laws of Tissue Engineering” (SH Teoh)
• Stent dissolves when tissue healing is almost complete
• Architectural Innovation
19. S-Curves - Stents
Performance
2006: reported that DES
pose an increased risk of
late stent thrombosis
Bioabsorbable Stent
2009: Abbott
2nd phase
clinical trial
Drug-Eluting Stent
(DES)
2006: 1st phase
clinical trial
Bare Metal Stent
(BMS)
2002: reduction of
revascularisation, benefit
of DES over BMS
Effort / Time
1986
1994
2006
21. Quick Industry Facts
The stent industry is highly competitive, due to
historical average 85% gross margins (2005)
Competition between firms mainly on basis of customer
relationships and product quality
High barrier to entry, requirements:
Manufacturing capability,
Relationships with physicians and FDA,
large sales force and brand
22. Quick Industry Facts (cont.)
High learning curves: FDA-approved
manufacturing process hard to surmount
No Network Externalities: Only externality being
brand reputation
Commoditization, mature market:
DES stent price drop from
2003 price of $3000 to
2011 price of $1400
23. Acquisitions show that…
The stent market is maturing
The decline in the number of operating
companies and the price drops indicates a
transition into a process innovation phase
Merger and Acquisition is the only viable
option for most small start-ups
32. Acquisitions 2006
Guidant
The 2nd worst deal in US history according to
Fortune Magazine, claiming that Boston Scientific
paid too much for Guidant
Boston
Scientific [5]
34. Technology and Industry Drivers
Newer Drug
Delivery
Mechanisms
Newer
imaging
Modalities for
better
Visualization
Demographics
Increased
Efficiency
and Efficacy
Potential for
Cheaper Stent
Platforms?
Introduction of
New Drug
Device
Combinations
35. Technology: To contract or integrate?
Dominant Design Paradigm: Paradigmatic Phase
Stents are hollow, mesh-like, elongated
structure, biocompatible, crimped on
Strong Appropriability
a stent delivery system
Regimes of Appropriability
Usually Strong Appropriability
Efficacy of legal mechanisms of protection
Complementary Assets: usually Specialized/Cospecialized assets
Vertical (Dis)integration
Channel Strategy
Factors include time-to-market,
price of stent (buy or make),
controlling the quality of stent,
incentives and options, etc.
Complementary Assets
Generic
Specialized
Innovator
captures most
of the value.
Innovator &
owners of
specialized
assets share
value.
Contract/
Outsource
Integrate
36. Network of Learning & Innovation
• Locus of innovation of
stents -- found in networks
of learning
• Large-scale reliance on
inter organizational
collaborations
Dedicated
• Invest / work closely with
universities
• Keen eye on potential
technology development
• Clinical Trials /
Evaluation with research
hospitals
• Purchase Rights to
Universities’ ideas
Research
Institutes &
Universities
• Exploration
• New radical
developments
• Knowledge
• Innovation
Vascular
Firms
Established
Pharmaceutical
Firms
• $$$
• Regulatory Savvy
• Inadequate facilities for
Basic R &D
• Manufacturing
• Marketing / Licensing
• Supply / Distribution
• Mergers & Acquisition
• Exploitation
37. Abbott Vascular
Division of Abbott (nutritional & pharmaceutical
products)
Global Leader: Cardiac & Vascular Care products
HQ at Northern California
Acquired Guidant vascular device division in
2006
Flagship product: XIENCE V (DES)
38. Abbott Vascular’s Success
Acquired Guidant’s vascular device division in 2006 with the
Xience V DES technologies, patent assigned to Abbott
Strategic move to gain entry into the coronary stent market
Pursued R&D (clinical trials) on Xience V and Ziomaxx DES.
Plans were to launch both stents & grab market share in the
rapidly growing DES market
In 2006, clinical trial showed Xience V as superior to Taxus DES
by Boston Scientific
Abbott withdrew Ziomaxx DES development program, focused
efforts for immediate launch of Xience in European countries,
followed by launch in the US. Time-to-market urgency crucial to
stay ahead of competitors
39. SWOT Analysis
Industry Leader
Global Presence
Heavy investment in R&D for product
innovation
Investment in Training & Education
Leverage via relationship with Industry
Professionals
Excellent clinical trial results for Xience V
(DES), shown to be superior to Taxus DES
by Boston Scientific
S
W
O
T
40. SWOT Analysis
Product Recalls: Powersail
Recent negative limelight
for incentivising a cardiologist,
Dr Mark Midei to implant its
stents
S
W
O
T
42. SWOT Analysis
W
O
Tight Regulatory Approvals
S
T
Late stage Thrombosis
and Major Adverse
Cardiac Events (MACE)
Mediated with
Surgical Imaging
Technologies such
as Portable
Ultrasound devices
Image obtained from
http://www.sciencephoto.com/image/2704
83/530wm/M3900535Angioplasty_techniques-SPL.jpg
43. How can Abbott capture a larger market ?
• Cost of Bare Metal Stent: ~$800
• Cost of Xience V Drug Eluting Stent:
~$1500-$2000
• Cost of Abbott’s Bioabsorbable
Stent: >> Xience V
Image obtained from “Controversies in Cardiovascular Medicine”
http://circ.ahajournals.org/content/114/16/1736.full
http://online.wsj.com/article/SB10001424052748704471904576230671702390088.html
44. Shifting the Battlefield: From Upper Class to Middle Class
Per Capital Income
Population
296 million
Disrupting
the Top:
1 billion in
headroom
Measured Leap
Downward- 2011:
2.4 billion in
Headroom
The
Bulgeoning
Middle
Class”
$30,000
723 million
$10,000
The “bottom
of the top”
2,397 million
$4,000
2,692 million
:
• Middle Class experiences major burdens with CABG Procedures. In developing countries,
surgeons may be ill-equipped to perform these procedures.
:
,
;
•Middle Class is expected to boom from 2 billion population to 5 billion in 2030.
• Tremendous upside potential once the firm finds a disruptive foothold at the bottom.
45. Disruptive Innovations as a Strategy- Abbott
Performance
Middle
of
Pyramid
Bottom of
Pyramid
Top of Pyramid
CABG
Reduced
surgical
complexities
Increased
Cost
Accessibility
Angioplasty
DES
BMS
Purples (XIECE V) and
Orange (BVS) by solid
arrows- currently
adopted by Abbott
Second growth wave: Reduction in Surgical
Complexities
Purples and Orange
dotted arrowsstrategies that Abbott
can adopt
Effort- Time
Third growth wave: Accessible Treatments to Emergent Economies
46. R&D, Networks and Alliances
When Resources are
Abundant
Systemic Innovation
R&D
Joint- Collaboration with distribution
companies to maximize market
penetration (With Caution)
Reduced time to market
Reduced costs to market
Interconnected framework for
success
Modular Innovation
Drugs and Drug Release
Technologies
Research and Operations Base
Leverage- Singapore a
biotechnology and Trade Hub.
Partnerships with Universities
and RIs
• Make larger R&D of
bioabsorbable stents
scaled in dimensions for
other biological
applications
• Centralize Research
Facilities in --- Drug &
Device Coupling
• --- Device Compatibilities
with Imaging
Specialized
Complement
ary Assets
• Freedom to Operate &
Protection
• IP Filing for new drug- device
couplings Where to File?
• Systemic Innovation+ Control Is
Important
• Acquire & Integrate
complementary assets
operations
•Integrate with Contract
Manufacturing Organizations
Alliances
•Get governments to
endorse large scale clinical
trials Overcoming
Regulations
•Work with Group of
Doctors in Hospitals-->
Establish De- Facto
47. Integrating complementary assets of stents
manufacturing, faster workaround of CE Mark and FDA
approvals
To remain as #1 leader in
Cardiac Interventions.
Target new, emerging
geographical markets
Reduce complexity of
techniques and use of
stents
Catch disruptive
waves for medical
innovations in
minimally invasive
surgeries
Establish de facto
standards of new
biodegradable stents.
Conclusions
There is at least 1
CAD is going to rise
intervention afforded
from 47 million DALYS by low- income
to 82 million DALYS in countries. (WHO)
2020. Where should
Abbott Aim?
Will Abbott’s stents be
made available and
affordable?
Editor's Notes
involves only a small incision through which a balloon-tipped catheter
Coronary stents, eventually disrupt the CABG Market to become the dominant mode of treatment in the market.Procedure rates for CABG and PTCA in New York State, 1982–2000. Source: SPARCS database, 1982–2000
Internalization = Learn by doing
2002: The reduction in the need for new revascularisation procedures has been the main clinical benefit of DES over BMS2006:reports began to hit the U.S. market that (DESs) might pose an increased risk of late stent thrombosis for some patients.
Bare Metal Stents -> Drug-Eluting Stents -> Polymer Coated DES
Bare Metal Stents -> Drug-Eluting Stents -> Polymer Coated DES
Source: MedMarket Diligence, LLC; Report #C245, "Worldwide Drug-Eluting, Bare Metal and Other Coronary Stents, 2008-2017."Drug Eluting Stents Segment Largest and Fastest Growing Segment in the Coronary Stents Market. Continues to lead the global coronary stent market, with a contribution of 83% towards it in 2009. The global segment is expected to reach $5.6 billion in 2016 after growing at a CAGR of 3% from 2009-2016.Source: Source: Report #C245, "Worldwide Coronary Stents Market, 2008-2017," published May 2009 by MedMarket Diligence.http://mediligence.com/blog/2009/05/05/drug-eluting-bare-metal-and-absorbable-stents-segment-growth-2009-and-2017/
1.000,00
Interventional cardiology medical device industry is similar to pharmaceutical or biotech industry, it is governed by regulatory approval such as U.S Food and Drug Administration (FDA).
the technological breakthroughs that level the playing field on the exploration front also create new opportunities for established firms in exploitationSmall firms require large firms’ financial support and regulatory savvy, while larger corporations desire access to the research prowess of smaller companies.