History is the basis of progress
Antonio Colombo believes that understanding the history of angioplasty is important because it enables you to know “how things are shaped, how difficulties are overcome, and how you are able to use intelligence, persistence, and knowledge to achieve goals”. In this interview with The Daily Wire, he talks about the challenges of angioplasty in the early days, his contributions to the field, and what he thinks are the problems that need to be solved in the future.
When did you start performing angioplasty?
I started my angioplasty activity around 1982, so about five years after Andreas Grüntzig performed the first procedure in September 1977.
At that time, performing angioplasty was really challenging. We had no stents, we had very primitive balloons, the guiding catheters were 8Fr or 9Fr, and you could not use two balloons at the same time—the kissing balloon technique had not been developed at that time. The other challenges included heparin having to be given post-procedure with the patient being given the drug overnight, and only the transfemoral approach being available. Furthermore, surgical back-up was essential—every week, we had two or three patients being transferred to surgery because of acute vessel closure.
Aside from Andreas Grüntzig, who do you think have been the key coronary angioplasty pioneers in the past 40 years?
Geoffrey Hartzler was a key figure; he was trained at The Mayo Clinic as an electrophysiologist before moving to interventional cardiology. He developed percutaneous coronary intervention (PCI) in acute myocardial infarction and PCI in complex patients; this was at a time when we did not have stents, so he was a pioneer. Other key figures include Richard Myler, who along with Simon Stertzer, started angioplasty in the USA.
What do you think have your greatest contributions to angioplasty?
I introduced dual antiplatelet therapy (DAPT) after stenting—using ticlopidine and aspirin instead of warfarin and heparin—to reduce bleeding and lower stent thrombosis. At that time, with bare metal stents, the rate of stent thrombosis was 5% to 6% even with optimal implantation. With the introduction of DAPT, stent thrombosis came down to 1% or even less.
I also introduced intravascular ultrasound (IVUS) after stenting to optimise outcomes and high pressure balloon dilatation. Before that, there were no high pressure balloons. I pushed the industry to develop a balloon that would go above 20 atmosphere; at that time, people felt that high pressure was not necessary or even that it was a crazy idea. However, I believed high pressure balloon dilation would enable operators to better imbed the stent into the vessel wall.
You are renowned for your work in complex PCI. What were your key achievements in this area?
I helped to improve bifurcation stenting and encouraged the use of debulking techniques (e.g. rotablation and atherectomy to modify the lesion).
I was instrumental in improving the technique to implant bioresorbable scaffolds. I used what is now called “PSP”—prepare the vessel, size the vessel appropriately, and post-dilate—from the very beginning.
Additionally, I helped to develop stents for long lesions—a condition that at the beginning of angioplasty was considered unsuitable with a percutaneous approach. I showed that you can place stents longer than 16mm and I also showed that you can put stents into small vessels.
What was your most memorable angioplasty case?
The first angioplasty case I will never forget. I performed this procedure with Richard Schatz, who was one of the pioneers of the Palmaz-Schatz stent. I remember the patient and still have a picture of him in my office. Unfortunately, he died of cancer about 15 years after the procedure. But, in terms of the procedure, he did very well; he did not develop restenosis.