Experts ponder future of vascular, cardiac intervention

HOLLYWOOD, Fla. — The field of intervention will look quite different in a decade, according to three experts at the International Symposium on Endovascular Therapy (ISET).

This year’s meeting featured a townhall session on innovation and the future of aortic and peripheral vascular therapy, structural heart and coronary artery disease therapy, and vascular surgery. According to Michael D. Dake, MD, Martin B. Leon, MD, and Richard Neville, MD, the future of intervention is bright and innovation continues at a rapid pace.

Aortic and peripheral vascular interventions

Factors that will drive change in vascular medicine include an aging population, more people with chronic degenerative diseases, a greater focus on personalized medicine, emphasis on cost containment, the emergence of consumer-driven health care, the replacement of palliation with restoration, the convergence of communication technologies with medical devices, advances in imaging and navigation that enable less invasive diagnosis and treatment, and improvements in materials science, according to Dake, who is the Thelma and Henry Doelger Professor at Stanford Hospital and Clinics, Stanford University.

Sensors will abound and connectivity opportunities enabling remote monitoring, disease management and device-to-device communication will be prevalent in areas including HF, diabetes, hypertension, Parkinson’s disease, epilepsy, bradycardia, atrial fibrillation, ventricular tachycardia, ischemia, depression and vascular inflammation, he told the audience.

Emerging procedural technologies may impact aortic and peripheral vascular interventions, Dake said, citing angiographic perfusion displays and robotics.

“The potential impact on medical care is enormous,” he said.

Coronary and structural heart interventions

While coronary intervention “has stabilized and most future changes will be iterative or incremental and not disruptive or transformational,” device innovations have “exploded” in structural heart intervention, according to Leon, who is professor of medicine at Columbia University College of Physicians and Surgeons, director of the Center for Interventional Vascular Therapy at NewYork-Presbyterian Hospital/Columbia University Medical Center and founder of the Cardiovascular Research Foundation.

In coronary interventions, “more precise diagnostics, integrating imaging and physiology, will become the norm, integrated with facilitated procedure guidance tools, to reduce procedure time and radiation exposure,” Leon, a Cardiology Today’s Intervention Editorial Board member, said. “Modern [drug-eluting stent] technology has been so successful that alternative platforms have been problematic, but other supplemental therapy devices may still be meaningful.” Such technologies may include ‘smart’ catheters and robotics.

While there is much excitement around developments to treat structural heart disease, “the evidence gap in structural heart disease is daunting and ongoing,” he said. “Planned studies will greatly impact clinical applications in the future. Device innovation, both iterative and disruptive, is exploding on the transcatheter valve space, given the anatomic challenges and the perceived clinical needs.”

Major advances in imaging for structural heart disease are also on the horizon, including the fusion of x-ray with 3-D transesophageal echocardiography and in-air medical holography, Leon said.

Vascular surgery

Factors that will impact the future of vascular surgery include a need for more surgeons as the population ages, changes in education and training, medical advances, guidance and monitoring, nanotechnology, regenerative medicine, genomics, information technology and personalized health, according to Neville, who is associate director of the INOVA Heart and Vascular Institute and vice chairman for in the department of surgery.

“Thanks to nanotechnology, I think we’re going to see miniaturized devices and more focused therapy on atherosclerotic plaque,” he said. “These will be placed percutaneously with catheter-based techniques. I think regenerative medicine will play a huge role. We already have valves that are being constructed with stem cells. This spring we will report data on vascular patch materials structured from stem cells that heal with a regenerative process so that in a matter of months, you can’t tell if the patch was there.”

By 2028, patients will be more likely to be treated at centers that combine “research, clinical care, education and health, wellness and rehabilitation,” he said. “The patient will arrive, be taken to the appropriate clinical area and have their genome mapped, they will undergo noninvasive total body imaging and all this will be fed into an IT system such as the IBM Watson database, which will sift through all the world’s literature and clinical trials. The patient will then consult with a vascular specialist, who will have access to an info-epidemiologist and a pharmaco-geneticist. Appropriate therapy will be determined, and if it involves an intervention, it will be performed by a vascular specialist who will have training on and access to all the appropriate interventions. After the patient goes home, the vascular specialist will be able to remotely monitor the patient’s status with implantable microsensors.” – by Erik Swain

Reference:

Dake MD, Leon MB, Neville R. Townhall: Innovation and the Future. Presented at: the International Symposium on Endovascular Therapy (ISET); Feb. 3-7, 2018; Hollywood, Fla.

Disclosures: Dake reports he is a consultant for Cook Medical, C.R. Bard and Novate Medical and has received research grants or other support from Cook Medical, Essential Medical, Novate Medical and W.L. Gore and Associates. Leon reports no relevant financial disclosures. Neville reports he is a consultant for Cormatrix, Graftworx, Tissue Analytics and W.L. Gore and Associates and receives grant or research support from Medtronic and W.L. Gore and Associates.