Andreas Gruentzig developed the balloon catheter method to carry out percutaneous transluminal angioplasty, a technique that clears narrowing of coronary arteries. It is likely that, without Gruentzig’s efforts, successful coronary angioplasty would have taken much longer to develop.
Arteriosclerosis—often called hardening of the arteries—is a disease in which arteries become hard and inelastic. The disease may affect a few arteries or it may be spread widely throughout the body. In some cases, arteriosclerosis causes hemorrhages because the diseased arterial walls become brittle and rupture. Arteriosclerotic hemorrhage in brain arteries results in apoplexy (stroke) in many people afflicted with the disease. In other cases, arteriosclerosis may cause loss of circulation in the extremities, leading to gangrene and the need for amputation of a limb. Complications of severe arteriosclerosis are a major cause of death resulting from cardiovascular disease.
Although severe arteriosclerosis is seen most often in middle-aged and aged people, some hardening of the arteries is present in people of younger ages. For example, large-scale studies of American soldiers in their late teens and early twenties showed evidence of the disease in about 80 percent of the test population. Furthermore, arteriosclerosis is much more common in men than in premenopausal women, and its incidence is virtually epidemic in the industrialized nations of the world. The prevalence and severity of the disease are particularly high in Northern Europe, in the United States, and in Australia.
The factors associated with the development of arteriosclerosis include overeating, high fat intake, sedentary lifestyle, emotional stress, and smoking. High blood cholesterol levels are viewed as being especially valid indicators of the future development of the disease, if it is not present already. Diminished intake of particular kinds of cholesterol is believed to be valuable as a preventive of the disease.
Despite the fact that millions of people afflicted with arteriosclerosis endure painful, disabling, or even lethal consequences, the methodology for successful treatment of the disease was slow in coming. In the 1960’s, nonsurgical methods reportedly provided the afflicted person little more than a chance to live with the disease. Furthermore, surgical intervention by bypass techniques was deemed to be confined to a few highly specialized vascular surgeons to aid the vast number of arteriosclerotic patients in industrialized countries.
The first relief of the problem occurred when Charles T. Dotter and Melvin P. Judkins,
Andreas Gruentzig (right) and a colleague examine the angioplasty device.
In the early 1970’s, Andreas Gruentzig, of the University of Zurich, developed a new type of catheter for use in transluminal angioplasty. This catheter used a small balloon that could be inflated after it was placed into the diseased portion of an artery. Inflation of the balloon catheter opened up the artery. The placement technique used was very similar to that of Dotter and Judkins, yet Gruentzig’s balloon catheter had the advantages of simplifying the operation and speeding it up.
Gruentzig began to modify the methodology to enable use of balloon angioplasty to clear arteriosclerotic blockage in the much smaller coronary arteries that feed the heart. He expected the modified method to allow appropriate patients to avoid long, complicated, and more dangerous surgical bypass methods that were in general practice at the time. Gruentzig’s efforts to develop the new technique included animal experiments and postmortem human studies.
By 1977, Gruentzig and his coworkers were ready to test coronary balloon angioplasty on an appropriate human subject. They carried out the first operation on a thirty-seven-year-old insurance salesman who had exhibited severe exercise-induced angina pectoris (cardiac-induced chest pain) because of arteriosclerotic blockage of one coronary artery. Gruentzig reportedly stated that the patient was enthusiastic about being able to avoid coronary bypass surgery “in spite of the fact that he was to be the first person ever treated with the new technique.” On September 16, 1977, the operation was carried out in the cardiac catheterization laboratory at the University Hospital in Zurich, Switzerland. Gruentzig reported that “the catheter was advanced to the arterial block with no difficulty.” He also noted that “the dilation of the balloon, twice, to relieve the blockage caused no chest pain and normalized the coronary blood pressure” in the patient. After completion of the operation, Gruentzig jubilantly stated that his colleagues were surprised that the procedure was so easy.
Sensibly wishing to avoid premature announcement of the success of the method, Gruentzig—with the cooperation of the press—avoided media exposure of the technique until 1978. At that time, a report of the success of his first five balloon angioplasty cases was published in The Lancet. Balloon catheterization, more formally known as percutaneous transluminal coronary angioplasty (PTCA), had become a reality.
A 1979 report by Gruentzig and David A. Kumpe (“Technique of Percutaneous Transluminal Angioplasty with the Gruentzig Balloon Catheter”) describes the methodology used. The advantages of the Gruentzig method over other procedures available included a diminished incidence of dangerous blood clot formation resulting from balloon catheter construction, the additional safety feature—that balloon expansion cannot occur beyond a predetermined diameter even if the desired pressure of the PTCA system is exceeded accidentally—and the ease and speed of the operation. Gruentzig cautioned that the technique should be performed by experienced practitioners who have been trained in an institution at which it is practiced often. In addition, he noted that optimum PTCA requires close cooperation among the radiologist, the surgeon, and other members of a complex operating team.
Gruentzig moved to Emory University in Atlanta, Georgia, amid much acclaim from his peers. He went on to perfect the technique and inculcate its wide use.
Andreas Gruentzig carried out the first balloon angioplasty in 1977. Without Gruentzig’s efforts, successful coronary angioplasty would have taken much longer to develop. However, the evolution of the methodology that enabled him to design the technique began forty-eight years earlier. In 1929, the first cardiac catheterization was effected by Werner Forssmann,
Thirteen years later, another essential event occurred: F. Mason Sones’s
By the early twenty-first century, physicians and medical researchers generally agreed that very few atherosclerotic arteries could not be reclaimed from the disease by prudent utilization of balloon catheters. The procedure became widespread and improved the lives of millions of atherosclerosis sufferers.
Much of Gruentzig’s work was limited to dilation of one diseased artery, and many patients with atherosclerosis exhibit multivessel disease. Fortunately, as sequels to Gruentzig’s effort, many advances were made in the years after the first balloon angioplasties were performed. The procedures changed, and the development of improved techniques facilitated the handling of multivessel coronary artery disease.
Furthermore, it became possible for physicians to use the procedures on many patients once viewed as being too high risk for PTCA. Part of the expansion of the application of the procedures resulted from the development of new safety measures (for example, the addition of oxygen carriers to the arteries). Also, procedures using lasers to facilitate removal of atherosclerotic blockage from arteries were developed, and many physicians came to believe that in the near future, the need for catheters would be eliminated.
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Dotter, Charles T., and Melvin P. Jones. “Transluminal Treatment of Arteriosclerotic Obstruction.” Circulation 30 (1964): 654-670. Pioneering article explains the Dotter-Judkins technique of percutaneous transluminal angioplasty in treatment of arteriosclerotic leg arteries. Presents the methodology used, the clinical cases studied, and the expectations of better future methods. -
Friedman, Steven G. A History of Vascular Surgery. 2d ed. Mount Kisco, N.Y.: Futura, 2005. Highlights many of the most important developments in vascular surgery from antiquity to the late 1980’s. Chapter 13, “Recent Advances,” places in perspective the work of Dotter, Gruentzig, and other contributors to percutaneous transluminal angioplasty. -
Gruentzig, Andreas. “Results from Coronary Angioplasty and Implications for the Future.” American Heart Journal 103 (1982): 779-783. Describes the Gruentzig methodology for coronary balloon catheterization and its results on hundreds of patients. Discusses the high success rate of the procedure, its advantages over coronary bypass operations, criteria for patient choice, and future implications of the procedure. -
Gruentzig, Andreas, and David A. Kumpe. “Technique of Percutaneous Transluminal Angioplasty with the Gruentzig Balloon Catheter.” American Journal of Roentgenology 132 (1979): 547-552. Describes the Gruentzig method in detail. Particularly interesting are pictures of the catheters and their guidance system, methodology of balloon inflation, and the case reports. Discusses the overall results of three hundred operations performed and followed up from 1971 to 1979. -
Hurst, J. Willis. “The First Coronary Angioplasty as Described by Andreas Gruentzig.” American Journal of Cardiology 57 (1986): 185-186. Brief account of the balloon angioplasty carried out in Zurich in September, 1977. Describes the basis of the technique, Gruentzig’s jubilance at its success, and his good sense in holding back premature publication of the results of the operation. Shows interesting aspects of Gruentzig’s personality and scientific ability. -
King, Spencer B., III, and John S. Douglas, Jr., eds. Coronary Arteriography and Angioplasty. New York: McGraw-Hill, 1985. Details many important developments in the area. Chapter 1 describes development of cardiac catheterization, from a clandestine self-test by Forssmann to Gruentzig’s work on PTCA. -
Tommaso, C. L. “Management of High Risk Coronary Angioplasty.” American Journal of Cardiology 64 (1989): 33E-37E. Describes advances in high-risk coronary angioplasty made in the period from 1977 to 1989, including specialized balloon catheters and infusion of oxygen-carrying substances to the artery treated.
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