I added a new category “tag” to the stent blog today: “Back to the Future.” And I hereby declare this to be an internet meme, even if it’s only a meme on this site!
I added this category because every TCT or ACC or AHA or ISET or ESC or EuroPCR meeting that I cover, I am struck by the fact that the newest, latest, greatest innovations are all ideas that were present at the genesis of this field of interventional cardiology.
And this is not just a product of my musings.
When I have interviewed Drs. Nico Pijls, Bernard De Bruyne, William Fearon, and Justin Davies, proponents of the modern-day fractional flow reserve (FFR) technology, I asked, “Isn’t FFR the modern version of what Andreas Gruentzig was doing with pressure gradients when he first invented coronary angioplasty almost four decades ago?” And the answer was, “Absolutely, yes!”
And I know from my documentation of this field that the idea of angioplasty first originated in reference to the leg or peripheral arteries. Therefore when I see a news article about “advances in the treatment of peripheral artery disease,” I think, “Well, after all, that’s where it all started….”
So today, when I received the news that Medtronic had completed its U.S. study on the IN.PACT drug-eluting balloon for use in the leg arteries, I thought, “Yes. Another notch in the ‘Back to the Future’ meme.”
Dr. Charles Dotter (who might easily be the real-life equivalent of Christopher Lloyd’s “Doc” Brown character in the “Back to the Future” movies — Dotter was known, after all, as “Crazy Charlie”) — so Dotter thought up this off-the-wall idea in the early 60’s and tried unsuccessfully to “sell it” to the U.S. medical community. His idea was to open up leg arteries from the inside out, instead of resorting to open surgery. The idea tanked in the U.S., but was taken up in Europe, and ultimately was discovered by a young German angiologist, living in Switzerland. That was Dr. Andreas Gruentzig, who in 1974 started doing peripheral (leg) cases with a balloon he invented, based on the concepts of Charles Dotter.
I wrote about this last fall in a post titled, “Angioplasty: From the Legs to the Heart and Back to the Legs.”
In that post, I included a clip from Charles Dotter’s film about angioplasty…which follows:
You will note that, at the end of this clip, Dotter refers to the possibility of “a future sophisticated attack on coronary narrowing…so much for the future!” Well, Gruentzig took this idea and successfully launched the subspecialty of interventional cardiology, now one of the most oft-performed medical procedures.
As it turned out, angioplasty was far more successful in treating coronary narrowings than it was in treating what would seem to be simpler more straight-forward disease in the leg arteries. There has been much written about this, but now, with the advent of drug-eluting balloons and drug-eluting stents, successful interventional treatment of the original target of angioplasty (the legs) actually might be achieved.
And, if anyone is still interested in these somewhat obscure historical issues, check out my award-winning documentary, “PTCA: A History.”
One Response to Back to the Future: Drug-Eluting Angioplasty Balloons, Dissolving Stents, FFR and More
Eugen — Thank you for your comment and you are, of course, correct. Gruentzig got the general concept of angioplasty from Dotter: opening up a blockage from the inside out. He first heard Dotter lecture at Eberhard Zeitler’s Nuremberg course in the early 70’s. But Gruentzig knew that to really make the procedure successful, he needed a better device than Dotter’s method of increasingly larger diameter catheters to push the plaque against the walls. I’ll bet that Dr. Porstmann was also at that symposium — he definitely was one of the physicians experimenting with other concepts, like balloons. Dotter also was playing with balloons — in fact some of them were made for him by a young resident in Orgeon named Thomas Fogarty! So certainly Gruentzig knew of Porstmann’s work and he set about finding the right material for a balloon that didn’t need a “cage.” He found it through a chemist who worked at the Technical High School across the street from him at University Hospital in Zurich: it was polyvinyl chloride. A PVC balloon could be made to expand to a fixed size and no greater, so it wouldn’t burst the artery. I have documented much of this story in my video, “PTCA: A History.”