Needles in Our Technology Haystacks
Defining Efficacy Is Easy, Characterizing Complications Is the Challenge
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- drug-eluting stents
- failure mode
- longitudinal stent deformation
- rare complications
- stent design
In this issue of Circulation: Cardiovascular Interventions, Rhee et al1 address an interesting aspect of technology development—the delineation of device complications in an era of accelerating innovation. They specifically sought to validate longitudinal stent deformation (LSD) as a design-dependent complication, pooling data from several studies using precise definitions, and longer periods of evaluation to overcome what they cite as shortcomings of prior studies.1
See Article by Rhee et al
This challenge of identifying failure modes is a modern feature of the ancient domain of innovation. From the beginning of time, nature, need, and innovation have been coupled. Indeed, the idea that “Art imitates Nature, and Necessity is the Mother of Invention” is ascribed variably to Plato in the 4th century Before Common Era, and Richard Franck in the 17th century Common Era. Art here adheres to its original definition, the harnessing of human creativity and the expression of innovation to provide new things to improve the human condition—technology. This dictum, irrespective of who elaborated it first, remains the governing principle of therapeutics—iterative and innovative imitation of nature to develop ever new means of treating disease. The flip side of this argument that is less well appreciated is that the complications that limit technology are the sine qua non for innovation. Without complications, there is no drive for creative solutions. The question that confronts us now more than ever is how to detect complications in the march of increasingly sophisticated innovation.
The story is well tread. Bypass grafting to reperfuse ischemic myocardium was embraced wholeheartedly until it became evident that only those with the most significant disease benefited and with a significant price. Balloon angioplasty allowed for immediate and minimally invasive intervention and, though originally intended to save time for the most ill to make it to the …