“Insui Shigen: When one drinks water, show respect to the person who dug the well.”
RAs 2004 comes to a close, it is an ideal time for us to reflect upon the developments achieved in endovascular therapy over the past year, not only to gauge how far we've come, but also to speculate as to what we might expect in what is sure to be a promising 2005.
Long-awaited FDA approval has been granted for carotid artery stenting, allowing appropriately trained physicians to offer their high-risk carotid revascularization patients a minimally invasive option to endarterectomy. For most interventionists, endovascular repair is now the first-line therapy for suitable aneurysms in numerous vascular beds, most notably the abdominal aorta. Drug-eluting stents now dominate the coronary stenting arena and may eventually make an impact in the peripheral vasculature. Exciting developments in nanotechnology and gene therapy are on the horizon. As last month's issue of Endovascular Today illustrated, novel therapies and enhancements to previous concepts are making lower-extremity intervention an increasingly utilized option, with today's restenosis rates showing improvement on historical data. Considering the vast evolution we have witnessed in endovascular therapy during the recent past, it is sometimes easy to forget that we are still in the nascent stages of this extraordinarily promising multidisciplinary field.
Our focus as interventionists must remain on continuing this trend of improving upon the remarkable progress those before us have already made. In order to do so, however, we must remember the previous milestones and understand how the processes by which they were accomplished have evolved. For example, in the early 1960s, Thomas Fogarty, MD, looked at a fundamentally flawed standard of care through optimistic eyes and used borrowed, unconventional materials to create the first balloon catheter. Within just a few weeks of his first thoughts concerning this idea, the first patient was treated with the device with procedural success. Forty years later, the cost of bringing a new technology to market exceeds millions of dollars, and market availability is achieved only after at least 5 years of development, testing, and thorough regulatory review and approval.
Developing our understanding of the history of endovascular therapy is an essential step in shaping its rich future. For this issue of Endovascular Today, we asked several of the true pioneer-inventors in our field to recollect the specific details regarding how they came to conceive of their inventions, as well as the period in which they developed these technologies. In presenting the perspectives of inventors who have brought their technologies to the medical community during very different time periods and regulatory environments, we hope to provide a fresh perspective not only on how these technologies impacted our practices, but also on how we now bring new therapies to today's patients. Understanding this evolution should provide insight into the ideal framework for developing and bringing to market new technologies in the future.
We begin with Dr. Fogarty's inventing the balloon catheter, which along with the early work of Charles Dotter, MD, essentially marked the birth of modern endovascular care. Seeing an opportunity to improve upon patency rates after balloon angioplasty, Julio Palmaz, MD, devised a plan to keep arteries propped open using a stent—another technology that changed the face of vascular care. Several years later, Juan Parodi, MD, introduced EVAR, which revolutionized the treatment of abdominal aortic aneurysms. Perhaps the biggest news of 2004 was the approval of CAS. This approval came after many years of hard work by numerous individuals and organizations, far too many to name here, but it would not have been possible without the invention of the embolic protection device and subsequent work on the landmark SAPPHIRE trial by Jay Yadav, MD. John Bergan, MD, who was among the first to realize the importance of Dr. Parodi’s work, presents us with a firsthand look at these events and more.
We were fortunate to have the opportunity to sit down with these pioneers and discuss with them some of the epoch moments in endovascular therapy. We hope the articles derived from these interviews will provide not only an interesting read, but also a greater understanding of the critical events on the endovascular timeline. An old Chinese saying teaches one to thank the person who dug the well every time one drinks water. It also teaches one that knowing history leads to new discoveries. Without these pioneers' contributions, we would not be able to do what we do today. Every time we inflate a balloon or deploy a stent, we should acknowledge how we got here.