The First Human case in Angioplasty
Percutaneous transluminal coronary angioplasty (PTCA)
Charles Dotter came up with the idea of angioplasty, opening blockages from inside an artery using catheters and avoiding open surgery.
Although he had success in peripheral arteries, his idea was rejected by vascular surgeons in the U.S. as “crazy.” But the idea traveled via Eberhard Zeitler and others to Europe, where a young angiologist, Andreas Grüntzig, made this crazy idea work in the coronaries.
The First PTCA - 1977
For Andreas Grüntzig, it was not an accident or an unexpected incident, but an event that had been months in the planning.
It came after intensive work taking place over seven years during which experience was accumulated with peripheral artery dilatations, animal data, necropsy findings and intra-operative coronary artery dilatation observations it was all this that allowed Andreas to be ready to use this technique percutaneously in humans. It was also extremely difficult to find the ideal patient.
LAD lesion pre and post PTCA procedure
Follow-up at 10 years. Still patent!
Follow-up at 23 years. Still patent!
Follow-up comparison from 1977 to 2014
37 years later, patient had recurrent angina. The original lesion was still open! 2 additional lesions were found and he received 2 drug-eluting stents.
Perspectives from Marko Turina, Cardiac surgeon who enabled Andreas Gruntzig to do his initial canine angioplasties and was also present during the first case.
Gruntzig’s original, home-made coronary dilatation catheter with continuous distal perfusion, used in canine experiments.
First experimental percutaneous dilatations of canine coronary stenoses in an experimental cardiac surgery lab in 1974/1975.
Experimental set-up for dilatation of a proximal branch of the left coronary artery in a dog. An artificial stenosis was surgically created with a 6.0 silk snare.
A Schneider AG double-lumen dilatation catheter was advanced through the guiding catheter into the stenosis. Its central lumen was perfused with blood from the right femoral artery by a roller pump.
Significant canine CX stenosis successfully dilated with Grüntzig catheter.
We can see the pressure gradient between the aortic pressure (AoP) and the coronary pressure (CoP) before dilatation. It disappears after dilatation.
Lessons learned from PCI beginnings in Zurich
- Necessity of a thorough experimental evaluation prior to clinical application
- Strong interdisciplinary interchange and support between cardiology and surgery
- Perseverance in spite of temporary drawbacks
- Innovative idea might not be initially welcome in skeptical local community: “Nemo propheta in patria sua”