“Interventional medicine, as a discipline of non-direct vision diagnosis and treatment under the guidance of medical imaging, is the third major discipline alongside internal medicine and surgery, and an important means of treating diseases of the heart, blood vessels, tumors and other diseases, and has many advantages such as minimally invasiveness, reproducibility, accurate positioning, and fewer complications.” Recently, in the twenty-seventh Chinese Physicians Association Interventional Cardiology Conference, Ge Junbo, academician of the Chinese Academy of Sciences, pointed out that for coronary heart disease, ischemic stroke, peripheral arterial disease and other conditions characterized by vascular blockage, interventional medicine to “dredge” as the principle of treatment; for tumors, aneurysms, hemorrhagic stroke and other conditions characterized by growth or rupture, interventional medicine to “dredge” as the principle of treatment. For diseases characterized by proliferation or rupture such as tumors, aneurysms and hemorrhagic strokes, interventional medicine adopts the treatment of “blockage”. In addition, for structural abnormalities such as arterial entrapment, aneurysm, structural heart disease, etc., interventional medicine adopts “repair” as the treatment concept.
Ge Junbo
In recent years, interventional therapy guided by the theory of pan-vascular medicine has become the “golden key” to open the door to the real world of vascular diseases. The so-called pan-vascular refers to the intricate network of blood vessels in the human body, including arteries, veins and lymphatic vessels, including tumor vessels.
“Pan-vascular diseases are characterized by the fact that they all have vascular lesions as a common hallmark, posing a serious threat to the heart, brain, limbs and vital organs such as the liver and pancreas.” Ge Junbo said that such diseases widely involve several key areas such as cerebral arteries, carotid arteries, coronary arteries, aorta, tumor arteries, renal arteries and arteries of the lower limbs, posing a great threat to human health. Therefore, for the common characteristics of pan-vascular diseases, there is an urgent need to accelerate the pace of research and development and promotion of interventional technology, focusing on the research and development of innovative devices and the transformation of clinical trials, popularizing appropriate technology, and strengthening cross-cooperation and medical-industrial synergy between different disciplines, so as to build an efficient cooperation platform and promote the continuous progress of diagnosis and treatment technology.
It is reported that since the development of percutaneous transluminal coronary angioplasty (PTCA) in 1977, coronary interventional therapy has been constantly innovated, from the stent implantation in the era of bare-metal stent (BMS) to the emergence of drug-eluting stent (DES), and then to the emergence of completely biodegradable drug stent (BRS) and drug-coated balloon (DCB), and each advancement has brought better treatment for the patients and better survival quality. outcomes and quality of life for patients.
China has also developed its own characteristics in the development of coronary intervention. Over the past 40 years, China's coronary interventional therapy has gone through three phases: “starting”, “vigorous development and rapid progress”, and “continuous improvement”. In terms of coronary chronic total occlusion (CTO) interventional therapy, since the establishment of the China Chronic Total Occlusion Club (CTOCC) in 2005, based on the CTOCC platform, the success rate of CTO interventional procedures has been increasing through constant precise selection of instruments, judgment of lesion sites and timing of procedures.
“Nowadays, China's CTO interventions have stood at the international forefront.” Ge Junbo pointed out that in today's era of rapid development of medical science and technology, China Smart has brought new breakthroughs in the field of global cardiovascular disease diagnosis and treatment with its unique innovative power and strong strength.
For example, the Microlight multimodal cardiovascular OCT - Cornaris P80 is not only equipped with top-resolution intracavitary imaging platform OCT technology, but also integrates a number of cutting-edge technologies, including plaque stability assessment (IPA), coronary vascular functionality (VFR) and artificial intelligence-assisted diagnosis (ICA). With a simple OCT scan, clinicians can quickly obtain comprehensive and accurate diagnostic data, which greatly improves the diagnostic performance of coronary heart disease endoluminal imaging. It also innovatively integrates China's original plaque stability assessment tool, Radial Wall Strain (RWS), which can effectively predict the risk of acute myocardial infarction in the future.
In the field of heart valve disease interventional therapy, especially transcatheter aortic valve replacement (TAVR), studies from PARTNER to CoreValve series have continuously confirmed the reliability of TAVR, laying a solid foundation for its wide application.
Ge Junbo pointed out that, with continuous technological innovation, the indications for ball-expanded and self-expanding valves are gradually expanding from very high-risk patients to intermediate-risk and even low-risk patients. Globally, the volume of TAVR surgeries is growing rapidly and has even surpassed that of traditional surgical aortic valve replacement (SAVR). By the end of November 2023, the cumulative number of TAVR surgeries in mainland China had reached 37,552, showing a strong trend of year-on-year growth.
It is worth mentioning that according to the recommendations of several valve guidelines at home and abroad, the applicable age range of TAVR is gradually being relaxed, meaning that more patients will have the opportunity to benefit from this innovative technology. And China has been at the forefront of the world in the field of diastolic valve interventions. As early as 2015, the Chinese Expert Consensus on TAVR took the lead in including diastolic valves in the indications, demonstrating China's foresight and practical courage in this field.
In addition, in terms of TAVR technological innovation, China has also realized a major shift from transapical to transfemoral aortic regurgitation-specific devices, and continues to deepen its coronary obstruction prevention and access preservation programs. At the same time, the exploration of the whole life cycle management of young patients and new valve materials, especially the research of polymer polymer valves with many advantages, also brings a broad prospect for the development of heart valve interventional therapy.
“In the field of cardiovascular intervention, the success achieved by percutaneous coronary intervention and TAVR technology has undoubtedly provided valuable experience and inspiration for mitral and tricuspid valve interventions.” Ge Junbo said that since the birth of MitraClip in 2003, transcatheter mitral rim-to-rim interventional repair therapy has started a new journey, and the research and development of related devices is in full swing.
In particular, transcatheter mitral valve repair (TEER) has shown excellent results in patients with heart failure combined with mitral regurgitation (MR) with reduced ejection fraction, and has even been listed in European and American guidelines as an indication for surgery in high-risk, anatomically appropriate MR patients.
The improved performance of the new generation of TEER devices, the learning curve for physicians, and the shortening of the procedure time mark the growing maturity of this technology. Among them, the ValveClamp, the world's first transapical mitral clamp, has been popularized in more than 50 hospitals nationwide in more than 400 patients with satisfactory results.
The results of the CLAMP-2 study, a national multi-center pre-market clinical trial, showed an acute success rate of 97%, a 1-year effective endpoint rate of 87%, and 88% implantation of a clip in an average time of 19 minutes. Meanwhile, ValveClamp was approved for marketing in September last year, becoming the first domestic minimally invasive interventional device for mitral regurgitation to be marketed in China. Currently, ValveClamp has gone out of China to bring hope to more patients.
“Although the efficacy of TEER has improved significantly and is getting closer to the level of surgery, only a few patients with mitral regurgitation are suitable for interventional therapy, which is still far from the goal of popularizing the whole patient group.” Ge Junbo said that tricuspid regurgitation interventional therapy started a little later, but is progressing rapidly. The rise of transcatheter tricuspid valve repair technology has brought unprecedented opportunities for cardiovascular physicians.
In addition, the continued innovation and application of technologies such as transcatheter pulmonary valve replacement and valve-in-valve replacement (TVIV) have also injected new vitality into the field of transcatheter valve therapy.
“In the face of the broad development prospects of interventional medicine, China has actively formulated the development strategy of interventional medicine, promoted the research and innovation of new technologies and devices, and constructed new norms to enhance the safety, efficiency, precision and medical service level of the treatment means.” Ge Junbo pointed out that total interventional therapy remains the unswerving goal of interventionalists, while surgery will continue to play its important role in providing a solid backing for interventional therapy. With the continuous progress and improvement of technology, it is believed that China's interventional medicine will usher in a more brilliant future.
Originally published in Medical Science Daily (2024-04-12 Page 2 Highlights)
