Richard A. Schatz, MD, is best known as the coinventor of the first commercially available coronary stent, the Palmaz-Schatz stent, developed to prevent restenosis after balloon angioplasty. His research ushered in a revolution in interventional cardiology that continues today.

Schatz is now the director of the Cardiac Catheterization Laboratory and research director of Cardiovascular Interventions at the Heart, Lung and Vascular Center at Scripps Clinic in La Jolla, Calif.

In 1981, Schatz attended a course on balloon angioplasty conducted by the inventor of the technique, Andreas Gruentzig, MD. “It was really spectacular because Gruentzig had such a flare that he made it entertaining, and he was doing something that was so heretical and controversial that you could just sense the tension in the audience. That’s really what got my attention,” Schatz said.

A risky procedure

“People forget how risky angioplasty was then, but it was not unusual for four or five patients to end up going to the operating room and having CPR done because of an abrupt closure. Even during the procedures...someone from the audience would yell out, ’Take the balloon down, deflate the balloon, you’re going to kill him.’
“These were real things that hap¬pened, and it was exciting.”

Schatz was hooked. He convinced his boss to start doing angioplasties at the army hospital where he worked. The night before his first case, he was terrified. “It took a long time for that feeling to go away,” he said.

The early equipment was primitive. “We only had one guiding catheter, and it had no soft tip. It had a real sharp edge. The leading edge was very dangerous, and we’d be pushing that thing into the left main, into the right coronary, things we would never think of doing today,” said Schatz.

“It was a balloon on a wire, and you couldn’t even get the right bal¬loon. You couldn’t get the right size, the right length. They were hard to come by, and even the inflation equipment was almost prehistoric.

“We had this metallic gun with these cartridges, and you’d have to pull a trigger and the would blast off. It would open up the balloon, and then you’d have to deflate it really quickly. Sometimes the balloons wouldn’t even deflate.”

Improvisation needed

During his first angioplasties, Schatz often improvised. He described how he and his colleagues would take nitroglycerin tablets, grind them up, pour them through a miniport filter and then let the solution drip into a syringe. “Then we would blow that down to the coronary,” Schatz said. “So by today’s standards things were absolutely prehistoric, almost barbaric.”

He recollects success rates in the range of 60% to 70%, with 50% restenosis rates.

“The successes were so grand that when we saw patients leave the hospital in a few days, [we felt] that whatever risks or whatever complications there were, they were solvable problems,” Schatz said.

“And, indeed, that is what has happened every year. It gets easier and safer and better.”