A Forty-Year Struggle for Openness

In 1977, while I was busy with Star Wars and action figures, Andreas Gruentzig was using his kitchen-made balloon catheter to dilate and open a highly stenotic LAD coronary artery. Fixing atherosclerotic disease of the coronary arteries had previously required open heart bypass surgery, a procedure only 10 years old at the time. He had taken coronary catheterization, which until then had only been used for diagnostics and surgical planning, and became the first to perform transluminal interventional therapy. Unfortunately, it turned out that the coronary artery would often close either immediately or over the following days to months after balloon dilation. The next 40 years would be a struggle to learn how to keep the artery open. And complaining about George Lucas. Lots of complaining.   Plain Old Balloon Angioplasty: Balloon angioplasty, formally known as percutaneous transluminal coronary angioplasty (PTCA), deforms the coronary artery to overcome an acute thrombus or a stenotic atheroma. The forceful enlargement by its nature causes dissection in the vessel intima and distention of the adventitia. The defects in the endothelium are physiologically similar to a plaque rupture seen in acute myocardial infarction, and exposes the highly thrombogenic media to circulating platelets and coagulation factors. A thrombus forms over the site, and an occlusion of the artery can occur. The stretched elastic adventitia also has a tendency to recoil.   These two effects could ca...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs