Giuseppe Biondi Zoccai University of Turin, Turin, Italy METCARDIO, Turin, Italy gbiondizoccai@gmail.com

1. INVASIVE AND INTERVENTIONAL CARDIOLOGY: KEY STEPS Giuseppe Biondi Zoccai University of Turin, Turin, Italy METCARDIO, Turin, Italy gbiondizoccai@gmail.com

2. INVASIVE CARDIOLOGY

3. INVASIVE CARDIOLOGY • Branch of medicine focusing on cardiac and vascular disease, exploiting invasive approaches for diagnosis, prognostication or treatment

4. INTERVENTIONAL CARDIOLOGY

5. INTERVENTIONAL CARDIOLOGY • Branch of medicine focusing on cardiac and vascular disease, exploiting invasive approaches for treatment

6. 3000 B.C. • Egyptians perform with metal pipes bladder catheterizations and deploy reed fragments to treat urethral stenoses 400 B.C. • Catheters fashioned from hollow reeds and pipes are used in cadavers to study the function of cardiac valves.

7. 1711 • Hales conducts the first cardiac catheterization of a horse using brass pipes, a glass tube and the trachea of a goose 1844 • Claude Bernard coins the term "cardiac catheterization" and uses catheters to record intracardiac pressures in animals

8. 1929 • First documented human cardiac catheterization is performed by Dr. Werner Forssmann

9. 1941 • Cournand and Richards employ the cardiac catheter as a diagnostic tool for the first time, utilizing catheter techniques to measure cardiac output. 1956 • Forssmann, Cournand and Richards share the Nobel Prize. Cournand states in his acceptance speech "the cardiac catheter was...the key in the lock…”

10. 1958 • The diagnostic coronary angiogram — the key to selective imaging of the heart is discovered by Mason Sones

11. 1964 • Transluminal Angioplasty, the concept of remodeling the artery, is introduced by Charles T. Dotter, as well as the idea of permanent mechanical scaffolding • “My favorite conceptual trademark is a sketch that I did years ago of a crossed pipe and wrench. It’s a gross oversimplification, of course, but what it means to me is that if a plumber can do it to pipes, we can do it to blood vessels.”

12. 1967 • Rene Favaloro conducts first saphenous bypass graft surgery in Cleveland. Melvin P. Judkins develops his technique of coronary angiography

13. 1974 • Andreas Gruentzig performs first peripheral human balloon angioplasty in Zurich

14. 1976 • Gruentzig presents results of animal studies of coronary angioplasty at American Heart Association meeting

15. 1977 • First human coronary balloon angioplasty performed intraoperatively by Gruentzig, Myler and Hanna in San Francisco

16. 1977 • Gruentzig performs first cath lab PTCA on awake patient in Zurich; starting with this case, all PTCA data areentered into a worldwide registry; oral presentation of 1st cases at AHA gets 1 minute standing ovation

17. 1978 • Gruentzig conducts first demonstration course in Zurich, Switzerland; International Dilatation Society is established

18. 1986 • Coronary atherectomy devices are introduced; Jacques Puel and Ulrich Sigwart implant the first coronary self-expandable stents in Toulose, France

19. 1994-1995 • Balloon-expandable stents are proved safe and effective, even with a regimen based on aspirin and thienopyridines, without anticoagulation

20. 2002-today • Drug-eluting stents are proven superior to bare-metal stents and, at least in selected subjects, as safe as them

21. Interventional CardiologySummary of evolution Drug-eluting stent Guiding catheter Balloon 100% 5F 6F 7F 8F 9F Direct stenting Steerable guidewire Stent Brachytherapy DCA Rotablator 1977 1983 1986 1988 1993 1998 2000 2002-today Gruntzig Simpson Puel Bertrand BENESTENT Teirstein Sigwart STRESS King Modified from Michel Bertrand

22. What about the future? • Medical therapy • Patient and lesion selection • Functional assessment • Invasive imaging • Drug-eluting balloons • Bioabsorbable stents

23. Thank you for your attentionFor any correspondence: gbiondizoccai@gmail.comFor further slides on these topics feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html