The First Generation of Angioplasty

Merriam Webster defines a human generation as the time from the birth of parents to that of their offspring. Typically, that time is 20 to 30 years. Thus, it has been 1 human generation from Andreas Gruntzig’s original description of balloon angioplasty in 1978 to its 30th anniversary in 2008.1 Three months after this report, one of us (B.P.O.) was born to a father (W.W.O.) who was starting his career in cardiac medicine. Thus, 2008 for us is a year of transition of a cardiac interventionalist from one generation to the next. At this time, it is fitting to reflect on the people, the procedure, and the practice in the first generation of angioplasty. In this issue of Circulation: Cardiovascular Interventions , Venkitachalam et al2 provide an overview of the changes that have occurred in practice and outcomes of the 1985–1986 National Heart, Lung, and Blood Institute (NHLBI) Registry and the NHLBI Dynamic Registry. The report highlights the remarkable distance we have covered with this procedure in a generation.Article see p 6 Imagine for a moment that you were a young investigator in 2008 and had invented a new device to treat coronary occlusions. You need to obtain millions of dollars in start-up funding and get institutional review board and Food and Drug Administration approval to initiate US clinical trials. The device is designed to treat young patients with stable angina, single-vessel disease, focal, concentric proximal lesions, and normal left ventricular function. The device has to be inserted through a 10F sheath and uses 9F guide catheters. Each procedure takes 3 to 4 hours to perform. Your success rate was 63% and the rate of myocardial infarction was 5%, with 24% of patients requiring coronary artery bypass (CABG) before discharge. How likely is it that funding would …