Cath Lab Digest

After completing a review of the article “Management of Detached Accunet…” by Chane et al., I found myself wanting to add something personal, a commentary. So I did, but it wasn’t enough. I therefore decided to reflect further upon our field’s “wonderful new technologies” and use this topic as the foundation for this month’s Editor’s Corner.

Just think about it: this is one of “the most perfect issues” for VDM readers. The use of new technologies, with a growing reliance, if not dependence, on innovative devices, is at the very center of who we have all become! Carotid intervention, aortic endografts and many other such things are great examples of how interventional medicine has changed in the span of only two or three decades. Procedures are no longer about “a surgeon and his tools” — tools that used to be fairly simple, even “rudimentary,” and in existence (essentially) since the ancestral beginnings of our craft.

Almost everything has changed. With the 1980’s as the fundamental starting point, our armamentarium has since incorporated a vast array of new tools and techniques, almost too many to remember. New paradigms have entered into our thinking and decision-making. We often find ourselves at the mercy of “clinical specialists” who have to “guide us” through the use of new devices, troubleshooting and the like. It is a whole new world indeed! And a bumpy road, full of potential obstacles, even peril.

Carotid stent intervention (CAS) is perhaps the best metaphor for what is happening. These “wonderful new technologies” have revolutionized who we are and what we do, but they have also added layers of complexity and potential failure and pitfall. To those interventional physicians who have not yet seen any of this, let me just say –— categorically — that you undoubtedly will as your experience grows. And then, you will understand how incredibly helpful having read (and remembering) an article such as the one from Chane et al. can be when resolving such a problem. We should feel indebted to our colleagues who are willing to share with us some of their darkest interventional moments, along with the important lessons that we often derive from such nightmarish scenarios. These communications are often more practically meaningful than the abundant reports on the many triumphs generated by such new technologies.