The Histroy of Angioplasty - the first balloon

To me, the most interesting character in the history of angioplasty was Andreas Gruentzig, a German Cardiologist, who first learnt of the angioplasty technique at a lecture by the American doctor Charles Dotter in the late 1960s. The method he observed did not use a balloon, but pushed a catheter through an occluded artery, a bit like a pipe cleaner.

Gruentzig hypothesised that a balloon catheter would be an improvement, however, he encountered resistance to his work to develop a balloon catheter in Germany so moved to Zurich in 1969.

Gruentzig presented the theory of his balloon catheter to the 1975 AHA meeting (American Heart Association). This was unfortunately met by widespread scepticism. However, Dr. Richard Myler did see potential in the technique and invited Gruentzig to San Francisco where they performed a direct method on an anaesthetised patient during by-pass surgery. This first attempt was a success.

On his return to Zurich the work continued and on September 16th, 1977, in the University Hospital, the first transluminal coronary angioplasty (PTCA) procedure on an awake patient with a balloon catheter was performed. This was with a catheter he made in his kitchen!

He expanded a 3mm section of the left anterior descending (LAD) artery. The immediate results were very good, with the patient remaining angina free. The patient was followed up on the 10 year anniversary of the procedure and the artery remained almost perfectly expanded. An excellent result, even by today's standards!

Gruentzig returned to the 1977 meeting of the AHA with the results of his first four cases. This time he was rewarded with a standing ovation. His amazing breakthrough and contribution to the future of cardiology acknowledged by his peers.

Gruentzig felt it was extremely important that he pass the techniques involved in this new procedure on himself. He was concerned that clinicians would not understand the risks and pitfalls without his guidance. He also continued to make catheters himself and kept this under tight control and distributed his creations with great care.

In late 1980 Gruentzig moved to Atlanta, having felt stifled by the bureaucracy in Europe.

Unfortunately, in October 1985, Andreas Gruentzig and his wife were killed in a plane crash in stormy weather, he was piloting the plane at the time. He was only 46 years old.

Amazingly, the catheters used today are still of a similar design to those designed on a kitchen table in the 1970's. His death was a great loss to the world of medicine.

The History of Angioplasty - an introduction

Unfortunately most of us have a loved one affected by heart disease. According to the Irish Heart Foundation approximately 10,000 people die each year from cardiovascular disease. This includes coronary heart disease, stroke and other circulatory diseases. It is the most common cause of death in Ireland, accounting for 36% of all deaths. The largest number, 22%, of these deaths relate to coronary heart disease . Also, 22% of premature deaths (defined as death before the age of 65) are from cardiovascular disease.

It was once a male disease, or predominately so, but not any more. I recently had a meeting with one of Germany's top Cardiologists. During the meeting one of his staff brought in a file for his signature. He reviewed the file, signed it, looked at me and said "There's equality for you, a 40 year old woman with two blocked arteries, you wouldn't have seen that ten years ago". Just what I wanted to hear as I stressed about clinical trial design!

So, angioplasty, what is it and why is it important?

The heart is a vital organ which pumps blood to the entire body allowing for the circulation of oxygen and nutrients and the removal of waste. Its a muscular organ which requires a good blood flow of its own. Heart disease generally involves the narrowing or blockage of the arteries supplying blood to the heart, thus preventing it from working effectively. This can lead to fatigue, shortness of breath and pain, among other symptoms.

Previously these blockages were treated by by-pass surgery. This is a complex operation where vein graphs are taken from another part of the body, typically the leg, and are used to 'by-pass' the blockages in the heart.

What angioplasty does is remove the blockage with only a tiny incision, normally in the groin, which allows most patients to go home the same day! A massive difference in both risk and recovery time.

A balloon catheter is inserted into an artery in the groin, the femoral artery and travels to the heart and into the diseased vessel. Once positioned across the blockage the balloon is inflated, opening the vessel to its original size. Several vessels can be treated during the procedure.

The cardiologist views the images using x-ray and radiopaque dyes. The catheters and guidewires used also have radiopaque markers at know positions to assist in the positioning of the instruments in the coronary arteries.

The image below shows a diseased artery as seen by a cardiologist. You can see the blockage mid way down the image on the left.

This second image is the aerty following treatment, with full blood flow restored.