Beginning of percutaneous coronary interventions: Zurich 1976–1977

Abstract

By introducing his concept of percutaneous coronary intervention (PCI), Andreas Gr€ untzig (Figure 1) has affected the most profound change not only in cardiology but also in cardiac surgery. This innovation started its triumphal march in the last 2 decades of the 20th century, but the idea was developed and experimentally tested in Zurich in 1974 to 1975. The concept of a balloon-tipped catheter to dilate arteriosclerotic lesions was doubted by many, and early clinical application of PCI was anything but straightforward. Having had the privilege to work closely with Andreas Gr€ untzig during the development of PCI in Zurich, I was invited by Dr Lawrence Cohn, Editor-in-Chief, to add some observations about this epochal discovery. Two observations emerge from Dr Gr€ untzig's early work in Zurich: (1) percutaneous balloon dilatation of the coronary stenosis was neither a divine inspiration nor a stroke of luck, but a product of long development and thorough experimental evaluation; (2) its first clinical application was by no means as simple as it appears today. FIGURE 1. Andreas Gr€ untzig.

Balloon Angioplasty – The Legacy of Andreas Grüntzig, M.D. (1939–1985)

“…With Senning’s support, Grüntzig began testing smaller balloon catheters for coronary arteries (Figure 11 ) in large animals ( 36 , 121 , 122 ) and human cadavers, with the help of his Swiss assistant, Maria Schlumpf, and the Croation cardiac surgeon Marco Turina, M.D. (born 1937) ( 122 ), and others. Turina, who at the time Senning had commissioned to perform the cardiac surgery in the experimental studies ( 74 ), remembers Grüntzig:…”

“…Grüntzig began to evaluate new, more refined and thinner coronary balloon catheters in canine coronary arteries ( 74 , 121 , 122 ) in which the surgeons had experimentally induced coronary stenoses (Figure 11 ). The first balloon dilatation of a coronary artery was performed in Zürich on September 24, 1975 ( 119 ).…”

“…Given the success of coronary balloon angioplasty in his experimental studies, Grüntzig was determined to test its feasibility in coronary artery disease patients ( 99 , 116 ). Only now, having successfully completed translational research that had already resulted in a new, non-surgical treatment of occluded peripheral arteries and established coronary angioplasty in experimental studies ( 74 , 121 , 122 ), Grüntzig applied for research funding from the Swiss National Science Foundation (SNSF). Within the next 4 years, he was awarded three SNSF research grants as Principal Investigator ( 125 – 127 ).…”

“…Grüntzig’s home institution continued to be hesitant to let him proceed with the PTCA procedure. The skepticism and resistance toward Grüntzig’s new approach expressed by his superiors in Zürich, Siegenthaler and Krayenbühl ( 38 ), is also reflected by the fact that Grüntzig had to wait for more than 2 months to have a second patient referred for this procedure after his first successful PTCA ( 122 ). As a consequence, 65 out of the 169 patients who underwent PTCA in Zürich came from abroad [the 8th PTCA patient was an American ( 160 )].…”

“…As a consequence, 65 out of the 169 patients who underwent PTCA in Zürich came from abroad [the 8th PTCA patient was an American ( 160 )]. In fact, even for the initial report of the first PTCA cases of published in the Lancet in February 1978 ( 161 ), two of the five reported PTCA procedures had to be done by Grüntzig at the University of Frankfurt ( 122 ) with the assistance of Martin Kaltenbach, M.D. (born 1928).…”