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MTG1 SeQuent Please balloon catheter for in-stent coronary restenosis with Dr Peter Groves

Dr Peter Groves, Consultant Cardiologist at Cardiff and Vale NHS trust and vice chair of the medical technologies advisory committee discusses implementation of the SeQuent Please balloon catheter in practice.

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This podcast was added on 1 Dec 2010

Podcast transcript

Podcast with Dr Peter Groves: NICE medical technology guidance on the SeQuent Please balloon catheter

Interviewer: Hello and welcome to the NICE podcast about the NICE medical technology guidance on the SeQuent Please balloon catheter for in-stent coronary restenosis. In particular this podcast will be focusing on implementing the recommendations in the guidance.

I am Katie Worrall, a nurse, and the implementation lead for this guidance. With me is Dr Peter Groves, Consultant Cardiologist at Cardiff and Vale NHS trust and vice chair of the medical technologies advisory committee.

Q1 Interviewer: Peter just briefly, what is the medical technologies programme?

PG: Well Katie the medical technologies programme is a new programme that has been designed to help the NHS adopt efficient and cost effective medical devices and diagnostics more rapidly and consistently within the NHS. We have just actually completed our first piece of guidance.

Interviewer: Thank you Peter. Just to highlight for those listening that there is a helpful podcast with Professor Bruce Campbell, chair of the medical technologies advisory committee on the NICE website and this contains further information about the medical technologies programme.

Q2 Interviewer: Moving on to SeQuent Please, Peter what is SeQuent Please?

PG: Well Katie SeQuent please is a special balloon catheter that is coated with a drug. (and) A balloon catheter is a device that we use to stretch open narrowings in heart arteries / coronary arteries and the drug in question that coats this balloon is used to treat and try and prevent the artery developing a re-narrowing process.

Q3 Interviewer: What type of clinical circumstances would SeQuent Please be used in?

PG: Well this is a group of patients who have ischaemic heart disease or coronary artery narrowings and patients who have this kind of condition often present with chest pain or angina. (and) Angina is caused by a restriction or furring up on the inside of the coronary arteries so that the delivery of blood to the heart muscle is reduced. (and) Once angina develops there are a variety of treatment options and one of those includes the use of interventional invasive procedures to try and expand those narrowing’s from the inside and to improve the circulation to the heart muscle. The difficultly with treatment of that nature is that re-narrowing can occur and the commonest treatment we use these days is implantation of a metal coil device called a stent to strap the artery to keep it open but narrowing can re-occur within that type of stent and SeQuent Please is a new treatment available once the re-narrowing has developed to try and treat the artery and reduce reoccurrence in the future.

Q4 Interviewer: Thank you Peter, when this re-narrowing happens how do we normally manage that?

PG: Now with the re-narrowing process there is the option of placing another stent inside the original stent.

Q5 Interviewer: Thank you just to clarify what are the potential advantages then for patients who are offered SeQuent Please?

PG: Well there are two main advantages, the first is that the likelihood of a recurrent narrowing, that is to say a return of a narrowing that will cause angina symptoms, the chance of that happening is reduced it seems but also because we are not placing another metal coil stent device into the artery the amount of treatment with blood thinning drugs that are required after a stent is placed is also reduced. So the two main benefits to patients are number 1; the likelihood of recurrence is reduced and number two the duration and time that they need to take additional blood thinning medications is also reduced.

Q6 Interviewer: Just to clarify which patients is NICE recommending this device should be used in?

PG: NICE is recommending that when re-narrowing occurs in a patient who has had a previous treatment with a stent that does not contain a drug, in other words a bare metal stent, then SeQuent Please should be considered as the next step of treatment. (but) In addition there are patients who have had re-narrowing in a drug eluting stent and in those patients under special circumstances SeQuent Please may also be considered. We are thinking particularly of patients in whom for example we want to reduce the duration of blood thinning treatment afterwards or patients for example in whom another stent device just cannot be delivered through the area of re-narrowing. Now in those two subgroups of patients it appears that SeQuent Please offers an additional treatment to the patient.

Q7 Interviewer: How will using this device improve quality and productivity in the NHS?

PG: Well the main benefit is obviously going to be for patients and the fact that if there is a reduced rate of re-narrowing subsequently then patients will require fewer repeat procedures and also as I have mentioned they will require less in the way of drug treatment so drugs will be for shorter duration. So overall there is a big benefit potentially to patients but also through these benefits there is also a potential reduction in the cost of patient care to the NHS.

Q8 Interviewer: What can clinicians and commissioners do now to help put this medical technology guidance into practice?

PG: Well I think the important thing is that local clinicians, cardiologists, interventional cardiologists, work closely with their commissioners to identify how they can implement this new technology within their local practice. We have identified fairy clearly subsets of patients who are likely to derive benefit. It is now I think important for local clinicians and commissioners to include this new technology within local care pathways to make sure that it is available to patients who really need it.

Interviewer: Thank you very much Peter. We hope that you have enjoyed this podcast and found the information useful in helping you implement the guidance in practice. For more information about the SeQuent Please medical technologies guidance please visit the NICE website.

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This resource should be used alongside the published guidance. The information does not supersede or replace the guidance itself.

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This page was last updated: 19 September 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.