The History of Coronary Angioplasty - the book
In 2017 we celebrate the 40th anniversary of angioplasty. As part of this celebration, PCR has chosen to launch a number of initiatives to commemorate which is surely one of modern medicine's greatest adventures. One of them is the production of a book, tracing back what started as a "crazy idea" to what has since then saved countless lives.
Technological development of the devices in interventional cardiology. From left to right: the balloon, the bare metal stent, the drug-eluting stent and the bioresorbable vascular scaffold. (Watercolour by Pierre Saumur MD)
From idea to reality - Philippe Gaspard
Today, no one could imagine that in the not too distant past the only function of a catheter was to visualize coronary arteries as required – when medical treatment failed – for coronary bypass surgery. However, this was the daily reality until 1977.
Charles Dotter’s “crazy” idea was to treat an artery with plumbers’ tools and without a scalpel in an attempt to decrease surgical mortality and morbidity. If it became a “reasonable” treatment, it was due to Andreas Grüntzig’s cautious pursuit, patience and perseverance into the unknown. His dream was to treat vascular disease percutaneously with a catheter in conscious and alert patients. The genius of Andreas Grüntzig allowed improvements to Charles Dotter’s tools in an effort to perform bal-loon dilatation of coronary arteries.
My purpose is to share this amazing story, one that challenged all of our convictions at the time –convictions which were based on our scientific knowledge of pathology. Herein we relive this story step by step, sharing the hopes, the disappointments and the strategies for developing interventional cardiology and enabling it to become the treatment of reference for coronary artery disease.
First, I would like to focus on the early pioneers in catheterization and coronary an-giography, then examine how an idea which initially came from the Americas was to evolve in Europe, only to go back to the United States of America. The first part of this book encompasses the “Saga of the Balloon”.
Coronary stents appeared ten years after angioplasty, as a result of a collaborative effort between the Old and the New Worlds. Substantial financial investments would be necessary so that “plumber” cardiologists could have increasingly sophisticated equipment. The second part of this book covers the “Saga of the Stent”.
In reviewing this history, my hope is to clarify each stage of development and to show how a thought process evolved from idea to reality, accompanied by an eager antici-pation from all involved. For each new milestone, I have attempted to report the initial randomized studies that confirmed the legitimacy of these innovations.
Understanding the past to build the future - Jean Marco
Philippe Gaspard lived this story from its very beginning. At a time when the major-ity of the cardiology community was expressing negative critiques, Philippe imme-diately understood that the future would be built by passing “from a contemplative to an active medicine”.
Returning to the facts behind this evolution, he illuminates for us the different stages of this incredible story, allowing us to “to relive this invention day-by-day”.
In doing this, Philippe Gaspard offers us a timely and exacting analysis of what took place, highlighted by his characteristic intellectual honesty. The clinical history is accompanied by those small anecdotes with which these “dreams” and “crazy ideas” evolved – even while the majority of cardiologists continued to say “this will never work”. This book succinctly illustrates the exacting steps that have produced the incredible clinical results obtained by coronary angioplasty, and follows in detail the different stages necessary between the idea of “breaking new ground” to be-coming the “transformative approach” it is today for our patients with obstructive atheromas of their coronary arteries.
Always accessible and highly readable, it offers us this evolution without making critical judgments, by allowing the reader to enter into the story and I highly recom-mend that all interventional cardiologists (young and less young) read and make their own judgments on the lessons that Philippe offers us of his encounters with Andreas Grüntzig.
What are these lessons? I believe that they are captured by some of the words and phrases we read in this book, such as “credibility”, “honesty” and “my patient’s out-come first”. Consider others like, “each failure must be analyzed with sincerity and objectivity to draw positive information and key learnings: how I could make it bet-ter next time” or “if I cause an occlusion by dilating this artery in this patient what will happen”. In this book Philippe presents us with a story that encapsulates “a step-by-step approach” or a “rigorous and honest assessment of the challenges”…and hones in on what is immensely important, “stay simple”.
Alongside these exhortations to intelligent and good clinical practice emerges the story of our specialty as it developed over these last decades, where the critical lessons and “key learnings” that we glean from this book and its anecdotes allow us to better understand our devices, the evolution of the stents we use, or the impor-tance and history of the randomized trials that have brought us to the point where we are today.
All educational initiatives have for their objective the goal of better understanding history, and this goes without saying concerning the history of coronary angioplasty. It is only by fully understanding the story contained in this book that we can fully construct the future, and this book must thus become one of the references in our domain – a story which has been transmitted to us by Philippe Gaspard in a fashion that is at one and the same time exhaustive, comprehensive and deeply honest.
With great admiration,
Knowledge and clinical skills are useless if they are not transmitted effectively - William Wijns
This book captures an evolution in medicine that began only few decades ago, and which flourished in the hands of the gifted, first practitioner of interventional medi-cine as we know it today, Andreas Grüntzig. It is an honor and pleasure for PCR, which in a very real sense is a direct descendent of that evolution, to present this work to you.
Interventional cardiology is a relatively young specialty and yet we have our founding myths and our Homeric heroes. Still, it is important to emphasize – for those whose careers were just beginning when our specialty was formed or those who came after – that these myths, like all founding myths, have a certain basis in reality. In our busy professional lives, it is important to remember that the development and evolution of the medicine we practice today depended on individuals like ourselves who, through a happy blend of education, innovation, chance opportunities and courage, advanced the field. Indeed, our heroes were very real, made up of the same flesh and blood alike ourselves and the patients that they – and we today – serve.
Knowledge and clinical skills are useless if they are not transmitted effectively. Clinical progress can only occur if we share, and share in a way that makes sense, with our fellow clinicians. To do this has been the lifelong goal of many of our heroes, professional organizations and communities. This desire to share and ex-change knowledge and clinical experience can be seen as the inspiration for the original meetings created by Professors Marco and Fajadet in Toulouse and Serruys in Rotterdam which evolved into EuroPCR, EuroIntervention and, finally, the Euro-pean Association of Percutaneous Cardiovascular Interventions, the EAPCI.
It is thus only natural that EuroPCR and the publishers of EuroIntervention, the first international, peerreviewed scientific journal dedicated to interventional cardiology, bring you this book, written by one of the witnesses – and participant – in this first generation of interventional cardiologists.
With his co-author Holly Whitin, who herself took part in the early elaborations of what has become a fruitful cooperation between industry and medicine, Philippe Gaspard recounts the evolution of our specialty – from its earliest awakenings at the beginning of the 20th century to the present. Philippe Gaspard offers us personal insights into the intelligence, but also the sweat, tears, determination and luck that was behind the “paradigm shift” that followed the work and leadership of Andreas Grüntzig. As you read this book you will see that the difficulties we faced in the past are similar to the ones we face today; that the challenges of providing the very best care for our patients have not changed and need to be approached then, as now, with the same blend of knowledge, clinical skill, rigor… and creativity.
This year, marking the landmark first angioplasty 40 years ago by Andreas Grüntzig, holds special importance for us all. This book is a fitting and living tribute to what occurred then, and allows us to better understand what made this revolution possible, with the implicit challenge for each and every one of us that we continue the work Andreas Grüntzig began and ensure the highest level of care for every individual patient.
Chairman of PCR