UT Cardiologists Celebrate 30 Years of Advances
in Coronary Angioplasty
HOUSTON – (Sept. 7, 2007) – Three decades ago, critics were calling coronary angioplasty a recipe for disaster. The notion that an inflated, miniature balloon at the end of a catheter could conquer heart disease was, to many, preposterous.
Dr. Andreas Roland Gruentzig didn’t let the skeptics dissuade him. He doodled designs on cocktail napkins, cooked up balloons and catheters in his kitchen and worked in laboratories to refine the instruments that would eventually allow heart patients the option of undergoing a knifeless procedure to push aside blockages in their coronary arteries.
On Sept. 16, 1977, Gruentzig performed the first angioplasty in a human heart – opening a choked artery in the heart of an insurance salesman and revolutionizing the treatment of coronary artery disease. With this procedure came a brand-new specialty called interventional cardiology.
Thirty years later, physicians at The University of Texas Medical School at Houston are celebrating the anniversary of angioplasty and the advancements they have helped bring to the field since the early days of interventional cardiology.
Richard W. Smalling, M.D., Ph.D.
H. Vernon “Skip” Anderson, M.D.
Richard W. Smalling, M.D., Ph.D., and H. Vernon “Skip” Anderson, M.D., both professors in the Department of Internal Medicine’s Division of Cardiology, will travel to Zurich, Switzerland to participate in an international coronary angioplasty conference Sept. 15-16 at University Hospital, where Gruentzig initiated a new era in the treatment of heart disease. The two Houston cardiologists, who treat patients in the cardiac catheterization laboratories at Memorial Hermann Heart & Vascular Institute – Texas Medical Center, are among only four physicians from Texas invited to give lectures at the international event.
Smalling will give a history lesson on debulking – a method by which artherectomy is used to remove large amounts of plaque. Anderson will present a lecture on the role of evidence gathering and its relevance to the advancement of treatments for coronary artery disease.
During the conference, the two physicians also will offer their perspective on accomplishments and disappointments in cardiac and vascular interventions over the last 30 years. Their reflections will be used in materials that will be presented Sept. 28 at the inauguration of the Andreas Gruentzig Exhibit at the American College of Cardiology Heart House in Washington, D.C.
Smalling and Anderson were both still in medical training when Gruentzig performed the first angioplasty. There were no textbooks on interventional cardiology. There was just Gruentzig, his data and his teachings, along with a few satisfied patients who were thrilled they had escaped open-heart surgery for a kinder, gentler solution to their chest pain.
Gruentzig’s medical milestone in 1977 didn’t make an immediate impression on either Smalling or Anderson, but today they agree his achievement ultimately shaped their careers as cardiologists.
Smalling said he was initially leery. “The technique was very crude. There was no way to really guide the balloon, and you just had to hope it went in the right place,” recalled Smalling, holder of the Jay Brent Sterling Professorship in Cardiovascular Medicine at the UT Medical School at Houston. “I held back a little bit.”
In the spring of 1982, Smalling decided to participate in one of Gruentzig’s demonstration courses in Atlanta – mainly because he felt angioplasty was a promising therapy for blockages in peripheral blood vessels. After that, he was convinced it was a viable alternative to open-heart surgery. He arranged to buy all the equipment that would be needed to offer coronary angioplasty in Houston. In June 1982, he performed the first angioplasty at Memorial Hermann. The 42-year-old male patient with a single blockage made a full recovery.
“By 1982, it was an approved procedure, but few cardiologists were offering it,” said Smalling, director of interventional cardiovascular medicine at Memorial Hermann. “In that first year, we didn’t do too many angioplasties. We had a group. I think we called it the Angioplasty Society, and we met with cardiologists from some of the other hospitals to review cases. Some were doing elective cases. At Hermann, most of ours were heart attack patients.”
Times have certainly changed. Approximately 1,500 coronary angioplasties and more than 1,000 peripheral angioplasties are performed annually at Memorial Hermann. Also, Smalling and Anderson, along with fellow interventionalists and physicians in the Department of Emergency Medicine, lead an initiative to quickly get heart attack patients into the Cath Lab for treatment to prevent catastrophic heart damage and death.
Anderson had the opportunity to train with Gruentzig as one of his research fellows at Emory University. Anderson was a believer, but he remembers the skepticism of others. “There was a belief that putting something inside the vessel would create more harm than good,” Anderson said. “So in those first years, it was a priority to come up with enough data to prove that it could be done safely.”
Other techniques – with names such as crackers, breakers, stretchers, drillers, scrapers, shavers and burners – came and went, but the angioplasty balloon always remained. “It is proven and valuable, and it continues to evolve,” Anderson said. “We’ve been able to help quite a few patients because of it.”
In 30 years, cardiac imaging and catheterization equipment, as well as the training, has improved remarkably, Anderson said. He added that one of the most significant advances has been the development of the stent, which is designed to keep the artery open after the balloon has cleared the blockage. “Now we have drug-coated stents to help heal the inside of the artery,” Anderson said. “As our understanding of pharmacology grows and the equipment improves, these stents will continue to get better and better.”
Anderson, Smalling and their colleagues at the UT Medical School at Houston continue to be at the forefront of research that is advancing interventional procedures for their patients. Their clinical trials have helped improve techniques and devices used to clear blockages in coronary arteries and carotid arteries, repair heart defects and stop a heart attack before it causes irreparable damage. Currently, some of their studies related to angioplasty include the use of stem cells, the timing of treatment and adjunctive pharmacology.
“Just as we are doing now, the founder of angioplasty was himself driven to collect and analyze data,” Anderson said. “He was driven by an unbelievable desire to show this was safe. That passion – that same drive – continues. We want to provide the safest, most effective treatments for our patients.”