Dr. Andreas Grüntzig was the designer of the modern angioplasty procedure. In that light, Dr. Serruys discussed current and future procedures, diagnostics and therapies important for cardiologists. These include the myocardial infarction center, technologies for diagnosis of plaque, new imaging techniques, myocardial infarction tissue repair and his dream of an automated device control.

Dr. Serruys indicated the myocardial infarction center improves treatment for patients with this illness, as currently demonstrated in Rotterdam. Upon admission to the hospital, patients are admitted to a special myocardial infarction unit. Patients are treated and sent to community hospitals for additional treatment or monitoring.

New diagnostic techniques are emerging to detect plaque and include tomography and elastography sheer stress imaging. Dr. Serruys discussed the use of the echothermal catheter in diagnosing plaque. This catheter is capable of multi-point tomography, simultaneous ultrasonic assessment of vascular stress/strain relationships and a temperature measurement. Temperature is important because an increase in plaque temperature of 0.5 degrees increases the risk of adverse cardiac events. This device images plaque and identifies the tissue in a vessel such as fat, fibrous tissue or the normal vessel wall. The catheter is currently being tested in humans, for widespread plaque the treatment is pharmacologic therapy. If plaque is isolated, catheter-based treatment is available.

Many imaging techniques are used to visualize plaque. These include magnetic resonance imaging, high resolution black blood imaging, multi-slide spiral computer tomography, and non-ionizing imaging. Dr. Serruys noted the advantages and disadvantages of each of these techniques. For example, while magnetic resonance imaging does not use radiation or contrast media, it has low resolution and reliability. Multi-slide spiral computer tomography uses contrast media and x-rays, but has high spatial resolution. This image visualizes the content of plaque such as calcium or soft tissue. Imaging can be used as a diagnostic tool or as treatment. Dr. Serruys believes non-ionizing imaging will guide all interventions because it can be repeated multiple times, has unlimited exposure time and reveals a 3-D image.

The repair of tissue damaged by myocardial infarction is in clinical trial in France. This technique injects autologous myoblasts into injured myocardium. The myocardial tissue regenerates and reestablishes electrical connections. Patients show symptomatic improvement with an increased ejection fraction of 13%.

Dr. Serruys imagines an automated device may someday be available to treat occluded blood vessels. This device would use imaging to navigate through blood vessels with a magnetic catheter and an ablating device. The operator would use a joystick to direct the catheter and ablate the occlusion.