Sir,
Just a short comment regarding the paper “40 years of PTCA” by Bernhard Meier:
I much enjoyed reading this fascinating account of the history of interventional cardiology - written by someone who has been actively involved from the first hour. Professor Meier has been close to the birth of a technique which has dramatically changed the face of our discipline.
Some of the statements are a bit provocative - which underlines the ongoing discussions and boosters the reader’s enjoyment. The author makes a point in stating that angioplasty was launched in Switzerland. Regarding what he - correctly - calls “the icing of the cake” however, namely the development of the coronary stent, he is less meticulous.
Among the “take home messages”, Bernhard Meier refers to the development of coronary stenting by stating that the first (coronary) stent “was implanted by Jacques Puel in Toulouse, France, on March 29, 1986”.
This statement, although factually correct, requires an explanation:
The first clinically used coronary stent has been initiated and developed in Lausanne in 1985 in Switzerland, in collaboration with local industry. Animal testing was performed at the University Hospital (CHUV), but the clinical testing was delayed for formal reasons, due to the meticulous processing of the Institutional Review Board (Ethics Committee). The impatience of the manufacturer (Medinvent) led him to ask Jacques Puel at Toulouse to ‘jump the queue’ and, in a somewhat questionable procedure, to implant a stent on a Saturday morning in a patient without the approval of an Ethics Committee and lacking a predefined indication!
The green light for clinical use of coronary stents has been given by the Swiss Ethics Committee a few days later in accordance with the Declaration of Helsinki (DoH). The Declaration is a set of ethical principles regarding human experimentation. It is widely regarded as the cornerstone document on human research ethics. - Within a week stent procedures started at the CHUV, according to rules. It took another three months to demonstrate the ultimate utility of stent implantation in medicine.
These facts underline the role of financial incentives which may lead to questionable shortcuts in the proper development of new treatment options. It remains astonishing that the French authorities overlooked these facts when the Toulouse procedure was made public. Be it as it may, the “take home message” about the first stent implanted in Toulouse, France, on March 29, 1986, called for this comment.
Ulrich Sigwart
