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Boston Scientific Corporation Message Board

  • buzzmarr buzzmarr Dec 30, 1997 6:51 PM Flag

    multiple answers..Radiology perspective

    WOW, what a bunch of questions..I am interested in all the answers concerning cardiology. I can answer some of the radiology
    questions. A couple of things to keep in mind..peripheral vascular work is much different that heart work. Those guys live in very
    small vessels, and I am usually in the 5mm and greater diameter unless a limb salvage procedure. The physiology is different in
    the heart than the peripheral vessels. If I stent a leg artery less than 5mm, the occlusion rate at 5 years is basically 100%.
    Cardiologist love vessels 5mm's and they have much less restenosis / intimal hyperplasia that we deal with. So to answer a couple of
    1. I get around DRG's because the vast majority of my patients are outpatients. The disease is long standing and if I can fix it, I keep them in over night then discharge them. So most of my stuff doesn't fall into the DRG's. If a person is having a heart problem..they can die and are more likely to get admitted. My patients legs just hurt.
    2. Our stents are cheaper...1000$ for symphony 1200$ Wallstent 1000$ Palmaz..sooo 900$ reimbersment (I don't know our actual figures) ain't so far off.
    3. Our stents are pretty much priced the same without consideration to size (maybe 100$ bucks variation)
    4. Plasty without stenting is very common. In fact the trend in our education is to go away from stenting due to the
    hyperplasia and restenosis. If you stent a large vessel and it PRETTY much have to go to surgery for a bypass. If you just
    plasty, you can repeat as needed. In the heart, you don't want to chance recurrent disease. Of course, if you dissect the artery
    stent time. That is usually in the iliacs and not more distal (vessels are a little stouter the smaller they getup to a point).
    Another consideration is we will plasty first and then stent based on pressure measurements across the lesion to determine pressure
    gradients. I may "look" ugly, but if no significant gradient and no dissection..a radiologist will leave it alone.
    5. and finally, NO we do not get paided by hospitals to use one stent over another. Unless you are a hospital employee, and some docs are, no money changes hands, but even then, I don't think that situation would come into play. Basically you order what you need and then use it. If one doc likes one thing and another doc likes something else, you may need to find some common ground so you don't have a huge inventory

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