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.
Q: How many angioplasties will be done this year? King: Well you know the numbers continue to go up, but the last
figure I saw was about 450,000, maybe now it’s 500,000 in the U.S.
and probably a comparable number elsewhere in the world. So we’re
probably getting close to a million interventional procedures in the
world now. When I say "in the world", you know, we used to talk about
the U.S. and Europe. But the growth in South America and Asia — I
just got back from India. I mean, it’s incredible the amount of interest.
And it all parallels the expertise. The number of people who are really
now beginning to be trained not only in the rudimentary aspects of
angioplasty, but in the most modern applications. Stents, everything
else.
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.
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