VCU cardiologists mark anniversary, look to the future

By Kristy Abato
VCU Strategy and Marketing

Twenty-five years ago this month, cardiologists at the VCU Medical Center were among the first in the nation to use balloon angioplasty to treat patients with blocked coronary arteries, a trend-setting breakthrough toward less-invasive heart treatments that continues today.

"The first time angioplasty was presented was at the American Heart Association's annual meeting in November of 1977," recalled Dr. Michael Cowley, professor in the Department of Internal Medicine in the Division of Cardiology. "There was a general feeling of amazement and enthusiasm with the presentation."

Soon after, Cowley and his colleagues, including Dr. George Vetrovec, professor and chairman of the Division of Cardiology, were trained to perform angioplasty. In fact, Cowley learned from the procedure's developer, Dr. Andreas Gruentzig in Switzerland, and worked in cooperation with colleagues at the National Institutes of Health in Bethesda, Md.

"Intuitively we knew that there should be a way to remove blockages in the vessels without surgery," said Cowley, noting that the catheter-based method essentially marked the dawn of medicine's migration toward minimally invasive surgery.

And, just as most early technological advancements begin with larger, inefficient equipment, so too did the first catheter-based balloon angioplasty devices. "The equipment was bulky and difficult to steer," recalled Cowley. "It was not user friendly." Success rates in the early days of angioplasty were between 50 percent and 60 percent.

Since then, angioplasty technology has improved to the point that it is considered fairly routine - more than 800,000 procedures are performed annually in the United States. Today, cardiologists at the VCU Medical Center enjoy a greater than 95 percent success rate in patients who undergo the procedure.

Over the years, the VCU Medical Center's Division of Cardiology has been at the forefront of medical advancements and in many instances has participated in clinical trials testing and developing new therapies and techniques.

Following the introduction of angioplasty, cardiologists here also were among the first to treat patients with vascular blockages using directional coronary atherectomy, a technique that uses a catheter-guided mechanical drill to shave blockages and stores the resulting plaque in a collection chamber that is removed when the catheter is withdrawn.

Next came the mechanical rotational atherectomy, a generation of mechanical drill that allows cardiologists to shave the plaque into tiny particles, which can then pass through the circulatory system. And the early 1990s saw the introduction of stents, tiny, scaffold-like structures used to prop open previously blocked arteries.

Most recently, drug-eluting stents, which are coated with a medication that seeps into the vessel lining and prevent reblockage, have proven quite effective. And, just as before, VCU Medical Center cardiologists were there at the beginning, as part of an elite group who tested and studied the latest advancement.

As one of the first hospitals in the region to offer the devices once they were FDA-approved, Dr. George Vetrovec said this advancement is particularly beneficial for patients who are high risk, such as the elderly and diabetics.

"These patients benefit by not having multiple interventions or surgery," he said. "From the beginning, we have been quite pleased with drug-eluting stents, since they appear to reduce the incidence of restenosis (recurrent blockage) by more than 90 percent compared with bare metal stents."

Vetrovec and Cowley believe that minimally invasive techniques resonate well with patients. "The whole field of intervention is moving toward minimally invasive treatments," said Cowley. "And not just in the coronary arteries. "We're seeing catheter-based interventions throughout the body," he said.