Five Questions

The inventor of the AngioGuard device discusses the state of innovation and technology in medicine today.

By Jay Yadav, MD

How did you come to invent and bring to market the AngioGuard embolic protection device? When I began performing carotid stenting, it was clear to me even before the first patient was treated that embolization was going to be a significant issue. Initially, we felt that simply refining our technique would allow us to limit the amount of embolization, but after some time, it became clear that this was not the case. I began working on filtration designs and discussing them with a few of the manufacturers, but none were terribly interested. They thought the device was either unnecessary or impractical, or that it was impossible to make a filter small enough to cross the lesion. I continued to research filters that had been successful in other applications and explored the principles behind their designs. Finally, I started a small company with a few engineers, and after we presented some positive animal data, manufacturers began to express interest in the device.

How would you describe the impact that the AngioGuard has had? I think it made a huge difference by giving specialists the confidence to proceed with carotid stenting. They knew they were capturing the embolic particles, and that the patient’s outcome was not a random event. Previous to the AngioGuard, it was somewhat like playing Russian Roulette—you just didn’t know for sure how the patient was going to fare. Most of the time the procedures went well and the patients would be safe, but there was no way to ensure that safety, and that can be a very uncomfortable position for a doctor to be in.

What do you feel are some of the most promising technological developments in vascular intervention today? The trend toward minimally invasive procedures continues and shows no signs of stopping. The development of percutaneous approaches to the mitral valve is very exciting. Obviously, prevention of restenosis after intervention using brachytherapy therapy and drug-eluting stents will be a major advance in peripheral intervention, particularly SFA and renal artery intervention. The whole field of wireless monitoring, which I’m currently researching, is very important for disease-state management, not only in the cardiovascular arena with monitoring pressure in AAAs, but also in congestive heart failure. The devices are very small and can be inserted at the time of surgery or percutaneously, and with a hand-held monitor, the patient can check the pressure in their aneurysm. The device also informs doctors automatically when there are pressure increases that require treatment.

What are some of the challenges you have encountered in your career, and how have you overcome them? Medicine is in general a conservative field, making it difficult to develop new ideas. There is often considerable resistance, which can be very personal and directed at the individual who is attempting to innovate. There are also significant political boundaries in medicine. There is not as much cross-fertilization between specialties as there should be; instead, there are turf issues, which are counterproductive and inhibit patient care. We are, however, seeing the climate improving. There is more collaboration between specialties, particularly in the endovascular arena, which is encouraging.

What is unique about the service provided at the Cleveland Clinic? What makes the Cleveland Clinic unique is the uniform excellence of the physicians who practice there, the shared ideals regarding patient care and clinical research, and the support we receive from the administration. Also, the fact that it is run by physicians and not corporate administrators makes a big difference. The hospital is focused on patient care, and I’ve found it to be a very productive place to work. n


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Endovascular Today is a publication dedicated to bringing you comprehensive coverage of all the latest technology, techniques, and developments in the endovascular field. Our Editorial Advisory Board is composed of the top endovascular specialists, including interventional cardiologists, interventional radiologists, vascular surgeons, neurologists, and vascular medicine practitioners, and our publication is read by an audience of more than 22,000 members of the endovascular community.