The History of the Treatment of Coronary Artery Disease

Early researchers like Leonardo da Vinci held a rudimentary concept of the function of coronary arteries, but significant understanding eluded mankind until nearly the 20th century. That was when the phrases "heart attack" and "coronary artery disease" were first used. Surgical techniques to alleviate the disease jumped to the forefront in the 1960s.

Early Discovery

• Leonardo da Vinci is thought to be one of the first to attempt to describe the workings of coronary arteries. Dr. P.R. Lichtlen, in his paper "History of Coronary Heart Disease," also credits another investigator, William Harvey, with discovering the "closed circulation of blood" in 1628 and describing its movement through the aorta and lungs.
  Others continued to advance understanding of the workings of this system, but it wasn't until the beginning of the 20th century that cardiologists such as William Osler and James Herrick significantly improved comprehension of coronary artery disease, with Herrick coining the phrase "heart attack." The first coronary heart catheterization was performed in 1929, resulting in a flurry of physician interest, and angiography (the process of making blood vessels viewable by x-ray) developed quickly during the 1950s.

Bypass

• A change occurred in the treatment of coronary artery disease in 1967, when Dr. Rene Favaloro initiated the first coronary bypass surgery at the Cleveland Clinic. This open-heart technique allows a physician to take a vein from another part of a patient's body and use it to connect the aorta and arteries in the heart, creating a "bypass" around blocked, coronary arteries. Blood and oxygen are then able to flow smoothly to the heart.

Angioplasty

• The first coronary angioplasty was performed in 1977 by Dr. Andreas Gruentzig at a Zurich hospital. "During the procedure, Dr. Gruentzig inserts a catheter (tiny tube) into a coronary artery that is largely blocked and inflates a tiny balloon (made at his kitchen table), compressing the buildup of plaque against the walls of the artery," according to The Society for Cardiovascular Angiography and Interventions.

Stents

• In 1986, stents were developed, which are tiny, metal tubes that serve to prop open the artery and keep it from closing again after balloon angioplasty. Drs. Jacques Puel and Ulrich Sigwart, working at a French hospital, inserted the first stents in a human coronary artery.

  In 1993, the U.S. Food and Drug Administration approved the use of the Gianturco-Roubin Flex stent. One year later, the Palmaz-Schatz stent received FDA approval on an elective basis. These two moves resulted in widespread acceptance, and the use of stents increased, drastically reducing the need for invasive, higher-risk surgeries.

Drug-Eluting Stent

• By 2002, more than two million coronary angioplasties were being performed annually across the globe. But restenosis, a re-blocking of the arteries caused by the body's attempt to heal itself after angioplasty and stenting, still forced 25% of patients to undergo additional procedures. The answer was a drug-eluting stent, a normal metal stent coated with drugs that interfered with the development of restenosis and dropped the rate of its occurrence to approximately 5%.