Martyn Thomas’ last act as President was to preside over a very successful Advanced Angioplasty 2008 meeting (January 24th & 25th), held at the London Hilton Metropole Hotel and incorporating the ‘Left Main 6+’ meeting on Wednesday January 23rd. This year’s two key visitors were Marty Leon (Cardiovascular Research Foundation, Columbia University, New York) and William Wijns (Cardiovascular Center, Aalst, Belgium, and current President of EAPCI - the European Association for Percutaneous Coronary Intervention). Dr Leon was kind enough to also be a panellist for each of the 5 live cases shown on the Left Main 6+ course. The Left Main course was organised by Simon Redwood and the cases transmitted from St Thomas’ Hospital. The transmission was a huge and faultless success with carefully selected complex cases, excellent operators and a very educational dialogue throughout the day. Particular thanks go to the visiting operators, Keith Oldroyd, Adrian Banning and David Hildick-Smith who were provided excellent support from their hosts (Simon Redwood, Martyn Thomas, Aldo Rinaldi and Brian Clapp). The case of the day was performed by Martyn Thomas and Simon Redwood – an elderly patient with poor left ventricular function and significant mitral regurgitation with a high surgical operative mortality; there was a very good demonstration of how to rota-stent (under balloon pump cover) calcified lesions at the ostium and mid-segment of the LAD and ostium of the Cx and the origin of an important obtuse marginal.
During the course of the day, William Wijns gave the first keynote lecture entitled ‘DES – overhyped, overused and overpriced?’. Being a consummate politician, Dr Wijns gave a somewhat philosophical talk in which it was impossible to determine what he actually believes on the subject! However, his thought-provoking presentation reminded us all of the need to search for better therapies than currently available. The subject was most timely given that BCIS was expecting the final draft of the NICE current assessment of drug-eluting stents during the course of the meeting.
The total number of attendees for AA2008 was 767, with a welcome increase in the numbers of consultants. The angio review break-out sessions continue to be popular, and some of the key trial results presented last year were reviewed. There were some excellent presentations on behalf of industry. The first morning was devoted to a review of current indications for PCI with a clear message emerging that we will be doing proportionately fewer elective cases and more work on patients with acute coronary syndromes. John Birkhead presented some fascinating data from the MINAP database, which suggested that outcomes were undoubtedly improving with the introduction of primary angioplasty. However, there are still relatively few units providing round-the-clock services and this will be a key area for BCIS over the next few years. Currently, the majority of patients in the UK are still being treated with thrombolysis, and Tony Gershlick reviewed the indications for PCI following this mode of reperfusion therapy.
Thursday afternoon started with a joint session between BCIS and the British Society of Endovascular Therapy (BSET), chaired by Professor Nick Cheshire. The current status of endovascular treatments for aortic dissection was reviewed, with a pre-recorded case being shown to the audience. This was an excellent session, and it is clear that collaborative approaches between interventional radiologists, cardiologists and cardiothoracic and vascular surgeons will be important in developing this specialty.
The day ended with a keynote lecture given by Marty Leon entitled ‘Interventional Cardiology – the unanswered questions’. This was a tour de force, with Dr Leon demonstrating his complete command of the current state of the art and the ongoing work to develop improved therapy, but then admitted he was somewhat bored with coronary intervention! He moved on to review the extraordinary developments that are occurring in other areas, and especially percutaneous aortic valve replacement.
On Friday morning, the continuing expansion of PCI in the UK was reviewed in a session aimed at opening a debate on how this activity is best delivered. Peter Ludman reviewed the literature on outcomes relative to volume of activity and case-mix and concluded that the link between these two variables could not be ignored. Neil Sulke gave a spirited defence of PCI activity outside of a surgical centre, but gave a balanced view of what activities should be provided in tertiary centres in the current era. Jim McLenachan then outlined why the unavoidable development of ‘Heart Attack Centres’ is going to influence this debate. Some strategic thinking is required at a regional level to ensure that the centres involved work together to provide a quality service.
Following a session on how to manage some of the problems that operators and their patients face (bleeding post-PCI, vascular access problems and coronary rupture), former BCIS President Professor Martin Rothman gave an overview of the history of PCI as seen from a UK perspective. This was timely, given that 2007 marked the 30th birthday of PCI, and 2008 the 20th birthday of BCIS. It was with sadness that Martin reflected on some of the contributions made by Raphael Balcon who had died following a long illness just a couple of weeks before this meeting. BCIS has developed from a small ‘club’ of cardiologists sharing their early experience to a national group leading the way forward for the care of patients in the UK. It is with considerable thanks to Martin Rothman, and more recently Keith Dawkins and Martyn Thomas that we have emerged as players on the international stage.
Three lunchtime break-out sessions were well-attended – one specifically for non-medical cath lab staff, one of tips and tricks on how to treat a number of complex anatomic variants, and one specifically aimed at SpRs training in interventional cardiology. Nick Curzen, who has done a major piece of work on the detail of the new curriculum and novel methods of assessment, chaired the latter.
Following a short presentation by Martyn Thomas on the current status of percutaneous aortic valve replacement in the UK, the meeting ended with four excellent presentations by selected SpRs of challenging cases they had been involved with. The judges decided that the ‘Best of the Best’ was the case presented by Dr Cara Hendry (Manchester Royal Infirmary) who presented a most miraculous save after a devastating coronary perforation; the case demonstrated numerous techniques on how to get out of trouble, team work by the cath lab, anaesthetists and surgeons, and remarkable perseverance in the face of adversity by Dr Farzin Fath-Ordoubadi and his team.
Many thanks go to the Programme Committee under Martyn Thomas’s leadership, together with Fiona Legate and her team at Millbrook for organising it. Many of the PowerPoint presentations presented at the meeting will be available on the BCIS website in the very near future.

Any comments or ideas for future meetings can be emailed to me at mark.debelder@stees.nhs.uk or via Lulu Ho at bcis@bcs.com.

Mark de Belder
BCIS President