Charles Dotter. MD
Angioplasty was born 55 years ago today when Dr. Charles T. Dotter, a radiologist in Portland, Oregon, performed the first angioplasty. But it wasn’t in the heart; it was in the leg.
An 82-year-old woman was suffering from great pain in her left foot because of blocked circulation in her leg. Her toes had become gangrenous and there was an non-healing ulcer. Amputation was recommended by the physicians at Oregon Health Sciences University, but the woman refused.
Dr. Frank J. Veith
Today was day one of the 45th Annual Veith Symposium in New York City. Started by Dr. Frank J. Veith, a pioneer in the field of endovascular approaches to vascular surgery, this five-day event covers the entire field of minimally invasive approaches to clinical situations that just a couple decades ago were the exclusive purview of open surgery.
The whole field of endovascular repair and intervention has grown exponentially since the first endovascular repair of an abdominal aortic aneurysm (EVAR) was performed by Dr. Juan Parodi in 1990, but it took quite some time to be accepted as a standard of care. Today the endovascular approach is the preferred procedure to repair an AAA and this is because of the advances in medical device design and manufacturing and the dedication of physicians to this less invasive non-surgical approach, physicians who will be attending this year’s Veith Symposium.
click for hi-res PDF of chart
For the interventionalist, proper sizing of coronary stents is critical. While imaging via angiography has been the standard for years, newer intravascular imaging technologies, such as IVUS and OCT, are becoming more widely used, as evidence accrues that these modalities make a difference in outcomes. For example, IVUS (Intravascular Ultrasound) not only allows the measurement of the exact open diameter of the vessel, as seen on angiography, but it shows the “invisible to angiography” layer of plaque. plaque that will be compressed, so that a more accurate post-PCI diameter can be determined. Under-expanded stents have been associated with increased stent thrombosis and restenosis. Continue reading
Abbott’s Absorb “Dissolving Stent”
There’s a lesson for the Absorb BVS in the history of interventional cardiology (an area of particular interest in this 40th anniversary of angioplasty year). There’s no question that the concept of a stent that dissolves and disappears is intriguing, and potentially clinically significant. Stents were invented because after balloon-only dilatation, the artery would sometimes collapse, or the spongy plaque would not compress neatly against the arterial wall, or the plaque would regrow, resulting in a very high rate of restenosis (reblocking of the artery).
Stents prevented all of this. Stents reduced the 3-5% acute closure rate that sent patients to bypass surgery after balloon angioplasty almost to zero. Continue reading
Last night news began circulating on Twitter that Abbott’s Absorb BVS (Bioresorbable Vascular Scaffold) was being withdrawn from the European market. This information was prompted by several physicians posting on Twitter a March 31 “Urgent Field Safety Notice/Physician Advisory” letter from Abbott addressed to “Valued Abbott Vascular Customer.”
A number of news sources, including this one, posted articles and tweets to the effect that the Absorb was being taken off the commercial markets and, as the letter stated, “Effective May 31, 2017, the device will only be available in clinical register setting at select sites/institutions that will play a pivotal role in the monitoring of this technology until Summer 2018 at which time the situation will be reviewed.”
This morning Abbott reacted to this initial flurry of reports that they had “pulled the Absorb” with some clarification: specifically that the Absorb is NOT being pulled from the market and still retains the CE Mark. An Abbott spokesperson told Angioplasty.Org, “Absorb will continue to be commercially available in Europe through the registries.”
But the relationship, as they say on Facebook, is complicated.
Washington Convention Center
Over the next three days, a voluminous amount of data will be presented, shared, and debated among an estimated 18,000 attendees of the annual meeting of the American College of Cardiology, this year held in Washington, DC.
While the meeting covers the whole spectrum of cardiology and heart-related issues, there are a number of studies and late breaking clinical trials specific to the subspecialty of interventional cardiology. Continue reading
Angioplasty balloon being manufactured on the kitchen table in Gruentzig’s apartment
Today marks the 39th anniversary of the first percutaneous transluminal coronary angioplasty (PTCA) which was performed in 1977 by Dr. Andreas R. Gruentzig in Zurich, Switzerland. This angioplasty procedure utilized an expandable balloon, fashioned on a kitchen table in Gruentzig’s apartment by Gruentzig’s assistant, Maria Schlumpf (note the bottle of wine…and yes, she used Krazy Glue). So, as I always ruefully think about on my own birthday, one is actually celebrating the completion of that numeric year, and sometime later today, coronary angioplasty will be entering its 40th year. Kind of amazing. Continue reading