1990s: Another Move

Extraordinary growth characterized the Catheterization Laboratory practice: the priorities were expansive driven by new technologies to treat patients and conditions/diseases (primarily CAD). It was also a transitionary time in that some of the new technology introduced in the 1980s did not prove effective in reducing problems and were either modified or replaced. Most of this technology was directed at understanding and treating the unmet issues in the field of revascularization for CAD. New collaborative networks of multinational investigators, types of technology available, scientific rigor along with expanded involvement from new additions to the staff as well as new trainees from around the world expanded the focus which remained on science, education, and patient care. New approaches to subset of coronary anatomy remained an important focus with an increasing number of acronyms: DCA, TEC, ELCA, VBT, and IVUS for devices and others for trials: CAVEAT 2, BARI, ISR, GUSTO, and SES. Mayo was the principle investigative site of the CAVEAT 2 trial of directional atherectomy for the treatment of saphenous vein graft disease. Restenosis continued to be a major focus – both clinically and scientifically. The newly developed animal laboratory under the direction of Rob Schwartz was oversubscribed with creative ideas; it developed a practical animal model which was used for multiple studies and facilitated testing and screening for both pharmacologic and device technologies to identify optimal strategies. Out of this came information which was important for VBT (vascular brachytherapy). The animal laboratory developed a radical approach of local site therapy for stroke prevention in the setting of non-valvular atrial fibrillation which came to fruition during the 2000s. Scientific studies focused on the role of natural killer “T” cells and inflammation in patients with acute ischemic syndromes. These acute coronary syndromes were also well studied with superb detailed delineation of important aspects of cardiogenic shock both in STEMI and NSTEMI. Close collaboration with regulatory agencies in developing standards of care as well as standards of performance for individual operators led to establishing an advanced qualification in interventional cardiology. New initiates were also undertaken with implementation of a robust program in vascular molecular biology staffed by the cardiac laboratory. There were other new initiatives – the development of a mobile catheterization laboratory service to provide diagnostic angiography at three of our outreach sites. This new approach, while controversial, was very successful, well received, and provided excellent, safe care. The most severe complication occurred when the mobile catheterization unit had a “run in” with a buck deer one early morning on the way to Austin, Minnesota. Only one party came away intact. With each of these, approaches to measure the long term benefit was developed. In this case, two of the three outreach facilities based on the initial experience with the mobile laboratory resulted in each of them developing their own stand alone facilities thus obviating the need for the mobile cath laboratory which was then retired.