Transcript “30 yrs of Angioplasty, 20 yrs of BCIS and

“30 yrs of Angioplasty, 20 yrs of BCIS and
now unprotected LM PCI..and on…”
Advanced Angioplasty 2008
Professor Martin Rothman,
London Chest Hospital
A journey in the field of interventional cardiology
`
Raphael Balcon
BCS President 1995- 1997
Tony Rickards
& Raphael Balcon
The first balloon use in treatment of CAD?
1685
Charles II - known to have 15 mistresses –
Moll – the most impertinent slut in the world
Whilst having a haircut, fell off chair with
large MI
Sixteen ounces blood letting - failed
Aloe, antimony, beet root, violets, camomile
flowers, fennel seed, saffron, cinnamon,
cardamom seed, linseed, rock salt, mallow
leaves
with a balloon of an animal bladder had this
lot shot up rectum He died !!
Management of IHD – US style..
1955
Dwight Eisenhower
Friday Sept 23rd 1955
CP during golf attributed to eating onions…
Mj General McCrum Snyder (21:30) mixed
him a cocktail !!
Milk of Magnesia
5 hrs (02:30) later morphine
Next day ECG
7 weeks bed rest !!!!
Origin of
Endovascular
Therapies
Crazy Charlie (Dotter)
Crude interventions…
with only large
shafted balloons,
inflexible wires, etc.
‘Ream jobs’
Volkswagen steering cables and guitar strings
Surgery…unfit for modern times
1960’s
World Figures in Interventional Radiology
Charles Dottor
1960’s
The Father of coronary balloon angioplasty
Andreas Roland Grüntzig
* June 25, 1939 Dresden
† October 27, 1985 Atlanta
East German refugee
PTCA
First dog
October 22, 1975
Schneider J. Infobl Dt Ges Kardiol 2:30-32, 1995
First Dog PTCA (LAD)
October 22, 1975
Schneider J. Infobl Dt Ges Kardiol 2:30-32, 1995
First Dog PTCA Series
1-Month FU
Schneider J. Infobl Dt Ges Kardiol 2:30-32, 1995
First coronary balloon catheter
(Grüntzig Dilaca DG 20-30, Schneider Medintag)
Used on September 16, 1977
First Shop for Coronary Balloon Catheters
First PTCA, Zurich September 16, 1977
PCI-Patient # 1
1977
Sep. 1977
First PTCA
and
Follow-Up
Apr. 2000
Dec. 2000
Sep. 2000
Sep. 1987
pre
Dec. 2000
post balloon
post stent (3.0 x 8 mm)
post balloon
PCI-Patient # 1
1977
September 16, 2007
Emory University
• Spencer King ‘Visionary’ to spot talent
• $105 million gift from Coca-Cola
• October 1980 moved to Emory
Raphael Balcon
1979 balloon inflations in coronaries during CABG
The Battle of the Balloons
1977-1985
Andreas Gruntzig
Bard/USCI
John B Simpson
ACS/Guidant
My first patient at London Hospital- 1982
European Coronary Angioplasty Workshop
Sept 12th – 14th 1983
The Battle of the Balloons
1985 - onwards
Paul Yock
John B Simpson
Bonsall
PreA small group of
cardiologists
from Yorkshire
and Lancashire
met in the
Railway Hotel in
Sheffield to
discuss 35mm
roll film angios
using a Targano,
to which a
number of
‘southerners’
came….ME!
1983-5
Andreas Roland Grüntzig
* June 25, 1939 Dresden
† October 27, 1985 Atlanta
Self-elected Group formed to write a constitution:




Peter Hubner
Alan Mackintosh
Man-Fai Shiu
Martin Rothman
The British Cardiovascular Intervention Society (BCIS)
• first meeting at St Bartholomew's Hospital, London
• 5th February 1988
• Accepted its constitution and elected its Officers.
Its purpose was to establish regular meetings for those
interested in interventional vascular procedures, and at
that time coronary angioplasty was still in its relative
infancy in the United Kingdom, with a national total of
just over 5,000 procedures being undertaken that year.
The Society has audited interventional activity in the UK
each year since then.
All the Presidents …..
Dr Man-Fai Shiu 1988-1992
Prof Martin Rothman 1992-1996
Dr John Perrins 1996-2000
Dr Keith Dawkins 2000-2004
Dr Martyn Thomas 2004-2008
Prof David Cumberland – the President we never had
Dr Man-Fai Shiu (President 1988-1992)
Dr Martin Rothman (President 1992-1996)
Dr John Perrins (President 1996-2000)
Dr Keith Dawkins (President 2000 - 2004)
Dr Martyn Thomas (President 2004 – 2008)
Dr Marc de Belder (President 2008- )
Dr Peter Hubner (Hon. Secretary 1988-1992)
Dr Huon Gray (Hon. Secretary 1992-1996)
Dr Mike Norell (Hon. Secretary 1997-2000)
Dr David Smith (Hon. Secretary 2000 - 2004
Dr Jim McLenachan (Hon. Secretary 2004 - 2006)
Dr Bernard Prendergast (Hon. Secretary 2006 - )
Dr Alan Mackintosh (Hon. Treasurer 1988-1993)
Dr Stuart Shaw (Hon. Treasurer 1993-1997)
Dr Paul Silverton (Hon. Treasurer 1997-2002)
Dr Neal Uren (Hon. Treasurer 2002 - 2006)
Dr Simon Redwood (Hon. Treasurer 2006 -)
Dr Huon Gray (Audit Secretary 1994-1997)
Dr Mark de Belder (Audit Secretary 1998 – 2002)
Dr Peter Ludman (Audit Secretary 2002 - )
And all the council members…..
Mr Chris Brown (Industry
Ms Verity Lea (Industry
Representative)
Representative)
Dr Raphael Balcon (LCH, London)
Dr Brian Maurer (Dublin)
Dr Adrian Banning (Oxford)
Dr Mike Norell (Hull)
Dr Nigel Buller (Birmingham)
Dr Keith Oldroyd (Glasgow)
Dr Anoop Chauhan (Blackpool)
Dr Peter Quigley (Dublin)
Prof David Cumberland (Sheffield)
Ms Christa Roberts (Industry
Dr Simon Davies (Royal Brompton
Representative)
Hospital)
Dr David Ramsdale (Liverpool)
Dr Adam de Belder (Brighton)
Dr David Roberts (Blackpool)
Dr Mark de Belder (Middlesbrough)
Dr Mike Rees (Leeds)
Dr John Dyet (Hull)
Dr Peter Schofield (Cambridge)
Dr Duncan Dymond (St Bart's Hospital) Dr Philip Spurrell (BJCA
Dr Huon Gray (Southampton)
Representative)
Prof Roger Hall (Hammersmith
Dr Rod Stables (Liverpool)
Hospital)
Dr Ian Starkey (Edinburgh)
Dr Alex Harley (Liverpool)
Mr Stephen Terry (Industry
Dr Ian Hutton (Glasgow)
Representative)
Dr Mazhur Khan (Belfast)
Prof Peter Wilde (Bristol)
British Cardiovascular Intervention, in PubMed Central will retrieve 2091 citations.
Intervention data collection in the UK
1988 National data collection started (Hubner)
1986 Surgical valve registry
1996 CCAD - funded pilot 3 yrs
(£1.2M grant – Ken Taylor & Martin Rothman)
2000 DoH agreed to continue funding
2002 First dataset agreed (version 5.1)
Tony Rickards instrumental in making CCAD data collection work
PCI vs Isolated CABG Numbers
(UK)
1991 to 2006
2006 data: Ludman
80000
70000
60000
PCI
CABG
50000
40000
30000
20000
10000
Note:
CABG data for financial yr
all PCI v NHS CABG
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
0
Form AB
Tony Rickards
& Raphael Balcon
“30 yrs of Angioplasty, 20 yrs of BCIS and
now unprotected LM PCI..and on…”
1992
PCI is 30 yrs old
BCIS is 20 yrs old
Advanced Angioplasty is 15 yrs old
What’s the next 20yrs for BCIS?
British Cardiovascular Intervention Society
British Cardiac Society
British Cardiovascular Society
What’s the next 20yrs for BCIS?
But remember the role of the cardiac surgeon
today, and his prior status, and be aware that what
goes round comes round….. unless
Cardiac & Vascular CAU
neurology
Care of the elderly
Critical care
trauma
cancer
Cardiology
Cardiac thoracic surgery + anaesthesia (cardiac critical care)
Diabetes
Clinical pharm
Vascular surgery
interventional vasc radiology
renal
Acute medicine
Stroke management
respiratory
Stenting for carotid artery
disease by
cardiologists…
Acute MCA Occlusion
Initial Angiography
After PBI with Neuroform stent
The enemy of good is better
He who fights and runs away lives
to fight another day