Interview
Spencer B. King, III, M.D., Part II


Last week we started 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. Dr. King currently heads the Andreas Gruentzig Cardiovascular Center at Emory, and next year will serve as President of the American College of Cardiology.

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Q: When PTCA was first developed, some people thought the idea was crazy. Now some refer to it as a "paradigm shift".
King: It was, and paradigm shifts don’t happen, you know, every day. Where does genius fit in? Where does a breakthrough, call it genius, call it charisma, call it whatever causes people to take a fresh new look at something. There’s always a place for that. People get staid. You get grant applications. Everybody’s in a mold of grinding out and moving in one direction. All of a sudden, some young investigator comes along and they want to do something very differently, and they throw out a wild idea. So we need ways for craziness to go on in science and in medicine.

I don’t know if I would characterize the development of angioplasty as craziness, but it was a little goofy — if “goofy” is defined as “what do most people think about it at the time?” — and you reflect on the poster that Gruentzig showed at Miami Beach in 1976. This was a dog experiment, ligating an artery, putting a balloon, blowing it up and restoring flow. I took a look at that, and I’m sure I wasn’t that different from most cardiologists looking at that, spoke to Andreas a few minutes and said “Hey, this is kind of interesting physiology here, but this has nothing to do with atherosclerosis. You can’t do this! You can’t get by with that!” And if I’m going to invest my energies into worrying about that, or the other 500 posters out here, I mean, you know.... It takes somebody to take an idea like that and have it percolate out of a vast sea of ideas, takes somebody with vision.

Some people had more vision than others. You know Richard Myler got interested because he had a prior interest in this subject — thinking about ways to mechanically open arteries. So if you come in there with some kind of background, that you’re a little bit interested in that, it may not sound quite as crazy as it does to other people who didn’t come in there.

Q: Why did Gruentzig wind up coming to the United States, specifically to Emory?
King: Well, Andreas started in vascular intervention, angiology. That was his field, and certain people got him interested in and moved him into cardiology. Willi Rutishauser helped him in that regard, among others in Zurich. But here was a young man, a very young man, who was developing these ideas about opening vessels and was working largely in the periphery. Then got into cardiology, something through the back door, if you will. Began to work in the cardiology unit there in Zurich, relatively conservative group. And as he became more successful, probably began to crowd the usual way of doing things a little bit.

His ambitions were quite extensive in terms of developing the technique. When I first met him in Miami Beach, when he showed his animal experiments, he was just an excited guy developing the science. Within a year, in 1977, he had done the first case, and then of course the worldwide attention focused on him. And, as that happened, he wanted to do more cases. He was limited in the number of cases he could do in Zurich, lab time, I think he was given about two days in the lab, that kind of thing.

And so in early 1980, at one of the courses, riding in the train out in the Emmenthal Valley, to a party, Andreas sat down beside me and started to talk about his idea of moving to the United States, which was quite far along, as it turned out. I didn't know about it. But he had discussed this with others already and he was thinking about where to go. And I said "Where are you thinking about going?" Just a casual conversation. Andreas said "Well, Cleveland is a famous place for surgery. And they do a lot of coronary work. And that's where Sones is. And they're interested in me and I might want to go there." And he mentioned Harvard, there had been interest shown. He mentioned Stanford, and Medical College of Virginia had made an overture. There were places that were interested in him.

So, as we sat there on the train, I said "Well, what are you going to do?" And he said "Well, I don't know." And I said, "What's your goal? What do you really want to do?" And he said, "Well, I want to expand the technique. As it goes forward, I see the necessity that it's going to grow and I'm going to lose control of it. And it may destroy the technique if it's not done right." He said, "I don't think I can do that here". So coming to the United States was really a way to develop this. He said, "I want to teach the technique. I want to shepherd it, and I want to be a professor."

You have to get inside the European mentality, and being a professor, you know, is quite something. So I said to him (maybe my friends in Cleveland will shoot me) but I said, "You know, that's not a medical school." Certainly at that time. "And therefore you can't be a professor at Cleveland Clinic. Okay?" So he kind of raised his antenna and he said "Well, what's your advice?" I said, "Well have you thought about coming to Emory?" And he hadn't really. And so, that was the first time I ever thought of it.

Whether it was the first time he ever thought of it, or whether that was the reason he was sitting beside me in the train, we'll never know. But the reasons he wanted to come to the United States were those that I enumerated. He felt that he had gone about as far as he could there in Zurich, with the constraints that were on him, and he needed a freer hand in developing angioplasty

Part III: In the final segment of this interview, Dr. King discusses how angioplasty was taught through the medium of live television.

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