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20th April 2022
Following Andrea Gruntzig’s seminal Lancet paper on Transluminal Angioplasty of Coronary Arteries in 1978 the take up of the practice in the UK was slow and haphazard compared with Europe and USA. It is hard to imagine now, but in the early 80’s opinions remained divided among cardiologists, including some experts in diagnostic angiography. Unsurprisingly cardiac surgeons were particularly cynical about the safety and effectiveness of the new technique. Any interested cardiologist has to overcome numerous barriers, including raising funding for the expensive equipment, getting hands on training on the technique and management of complications, and last but not least to convince non-participating colleagues to refer cases for consideration.
Doing PTCA in the early years means coping with bulky, non steerable balloon systems, non digital imaging chains with no instant review (that came in the late 80’s with VHS tape systems replacing 35mm cine films). For years only single vessel disease was deemed suitable and even so success rate was below 80% due to the occurrence of acute occlusions often leading to emergency surgical bailout. Surgical standby was mandatory and often lack of a free ITU bed means cancelling a whole list.
For most aspiring operators the main hurdle was funding. The large London centres had better access to ad-hoc funds, and a handful of key operators made a tentative start but were reluctant to share their early experiences. The lack of any open registry of number of procedures and success rates impeded any progress on increasing the adoption of the practice and UK.
Outside London the only active centre was in Sheffield where David Cumberland, an interventional Radiologist who knew Gruntzig personally, gathered a handful of cardiologists from Yorkshire and the Midlands and held weekly meetings. The group called itself the British Coronary Angioplasty Group with Cumberland as its chairman. The meeting venue was the Royal Victoria Hotel, chosen for its proximity to the Sheffield train station. I joined the group in 1982 when we would meet and present angiograms to discuss case discussion, feasibility for angioplasty and shared our experiences of successes and complications.
Meanwhile Edgar Sowton then President of BCS and already performing regular PTCA started the BCS working party on PTCA and invited me to write a report on the state of angioplasty practice (or lack of) in the UK (see box on timelines). I presented findings at the plenary sessions in the BCS meeting in Manchester and it generated a heated debate given the prevailing views on the new, unproven, expensive and hazardous procedure. The event helped to trigger a growing consensus that something had to be done to counter the negative image of PTCA.
David Cumberland felt that it was time for a change and he and about two dozen cardiologist met in Sheffield. New interim officers were appointed to start the process of forming a new society with the declared purpose of promoting coronary interventions through a process of regular meetings to discuss advances in the technique and equipment, sharing experiences of complications and their management. Schemes were drawn up for training programs and a national registry of coronary interventions. British Cardiovascular Interventional Society was born.
Despite the humble beginnings BCIS has obviously fulfilled the goals it set up to achieve. A somewhat surprising additional benefit was the levelling up of the regional and sub reginal centres without which the UK would have taken many more years to catch up on the delivery of what is clearly one of the most significant advances in medicine. More so than many other specialist societies the incorporation of BCIS and other sub-specialist societies under one umbrella of BCS greatly increased participation form consultants and trainees, and associated healthcare professionals.