Beginning this week is a multi-part interview with Spencer B. King, III, M.D. Dr. King worked closely with Andreas Gruentzig, the founder of PTCA, at Emory University from Dr. Gruentzig's arrival in 1980 until his untimely death in 1985. Dr. King currently heads the Andreas Gruentzig Cardiovascular Center at Emory, and next year will serve as President of the American College of Cardiology. The following interview was conducted on January 8, 1997 by Burt Cohen.

(Click here to access index of previous interviews.)

Q: How has the training aspect changed, other than just numbers? Is there a difference in the way people are being trained?
King: Well, when nothing much is known, then, of course, everything is new. And when Andreas began to teach, it was "see one, do one". That was it. Now training has become much more formalized. Twenty years from the time of inception to now, kind of a maturity of the technique, exemplified by the fact that now there's going to be a Board, in America at least. There'll be an official Board, sanctioned, run by the American Board of Internal Medicine, cardiology subsection. There has been one already for electrophysiology, that was a precursor of this. But now it's been decided that there should be one for interventional cardiology and all the preliminary work has gone into it and now the Board has been formed, an exam will be written and the criteria will be established for taking the Board.

And I think whatever happens in this country regarding interventional cardiology usually spreads elsewhere. Certainly in the training arena. We’re a little bit behind the curve sometimes in the ability to use the latest experimental technology, even if it’s developed in this country, as you know. But from the training aspect I think that we’ll continue to be the leader in training in interventional cardiology.

Q: Speaking of being "behind the curve", the idea of angioplasty really started in the U.S. with Charles Dotter. And while he developed the concept and actually did them peripherally, it had to travel to Europe and then come back here as coronary angioplasty. Could you trace that history briefly?
King: Yeah. You know Dotter was a real maverick in radiology circles when he developed the idea of intraluminal therapy, which was really his. Although the concept had been thought of before, I mean, Dotter is clearly the father of the idea of opening vessels from the inside. And he did it. He did it successfully, but his personality, his genius, was also his enemy, because he was ahead of the curve and he frightened people. It seemed crazy at the time. American radiologists didn’t follow through with it to any extent. It was carried forth in Europe. Zeitler continued it, among others. And that’s how Gruentzig got into the whole area of the Dotter technique. He picked it up from Zeitler and called Zeitler, approached Zeitler, got involved with him. Saw the Dotter technique develop, began to use it himself. And then he got the idea that this wasn’t good enough and it could never be modified for the coronaries. The Dotter technique using the periphery would have to undergo some radical change. And that’s how Gruentzig finally hit on the idea of balloon angioplasty, finally miniaturizing for the coronaries and the whole story went from there.

Q: Was Gruentzig aware that he had started a revolution. I wonder what he would have thought of the fact that in 20 years there would be a million angioplasties done annually? Would that have surprised him?
King: No. It wouldn’t have surprised him at all. He had an image of himself that he was different, and he had probably a very clear understanding of his impact on medicine. I don’t think there was any confusion in his mind about that.

Part II: Dr. King discusses how angioplasty was developed and spread.

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