Missoula cardiologist, Dr. Stan Wilson honored for groundbreaking work

"Cinderella got to go to the ball," Stan Wilson says of his trip to France to be honored for helping thousands of heart patients. "It was wonderful, absolutely wonderful."

Stan Wilson calls himself a "small-town cardiologist." He’s not a fame-and-fortune kind of guy. He likes to spend vacations at the lake, reading. And he loves his patients in his Missoula practice.

By GINNY MERRIAM of the Missoulian

http://missoulian.com/articles/2004/06/27/news/top/news01.txt

It has been those patients – and Wilson’s drive to solve the problems of their hearts – that have kept him chasing an idea for eight years.

Today, plaques declaring 16 patents hang on the wall of his office across the street from St. Patrick Hospital, where he works in the heart catheterization lab at the International Heart Institute of Montana. And Wilson has recently returned from Paris, where he was celebrated at a meeting of 10,000 to 12,000 heart specialists for his invention, which at long last is helping thousands of heart patients in Europe, Asia, Australia and New Zealand.

"Cinderella got to go to the ball," he says with obvious delight. "It was wonderful, absolutely wonderful."

The Multi-Link Frontier Coronary Bifurcation Stent System, manufactured by the medical giant Guidant Corp., was approved by the European equivalent of the U.S. Food and Drug Administration on April 21. That night, Wilson took his family to dinner at The Depot. They flew a balloon over the table, "Congratulations." Overseas, interventional cardiologists began embracing the new stent.

"This is a launch of a product. A launch," Wilson said. "A great word."

Of course, the 62-year-old Wilson is characteristically modest about himself.

"It would be incorrect to say that this was only me," he said. "If I listed all the people, all the engineers at Guidant, who made this as brilliant as it is, it would be a long list."

The bifurcated stent solves a problem that Wilson sees every week in his practice. As an interventional cardiologist, he intervenes in heart disease. Much of the work is opening – and keeping open – arteries that are clogged by fatty deposits, causing heart attacks.

One of the solutions, pioneered in Zurich in 1979 and used in St. Patrick Hospital’s cath lab since 1982, is angioplasty. In that procedure, the cardiologist inflates a balloon inside a clogged artery to reopen it and restore the flow of oxygen-rich blood.

In 1994, American cardiologists began using a revolutionary tool, the stent. The stainless steel tube looks like a tiny piece of chain-link fence. Working through an incision in the patient’s groin, the physician snakes the stent up to the site of the damage, or lesion, using a balloon on the end of a wire. The patient’s own tissues grow around it in four to six weeks, and the stent is incorporated as reinforcement for the artery.

Stents have become the best treatment, lasting longer, without more attention, than angioplasty.

That’s all simple enough on an artery’s straightaway, Wilson explains. But about 20 percent of the time, the patient’s lesion is at a junction, or bifurcation. As stent technology moved on, the bifurcation problem became a central challenge. How do you solve it? A stent on each branch leaves the junction unprotected. A stent at the junction could block one of the branches.

At the two major international cardiology meetings each year, Wilson listened. He went home and thought about it. In 1996, he talked to Guidant, where he had sat on the advisory board for a decade. They were interested, and Wilson gave himself permission to think about it formally.

He thought so much that he became a student of his own creative process. He looks back now and describes it as one of the first computers, shuffling and reshuffling the punch cards even when he wasn’t paying attention.

The pieces started coming together. Once he fell into bed after staying up all night with a sick patient, then working all day. When he was seconds from sleep, an idea came. Another time, he was concentrating on five or six very sick patients who had come in by air ambulance all day. Walking across the street in a snowstorm, another answer came.

"It’s been an incredible effort," he said. "Lots of false starts and dead ends, watching it unfold."

For six years, two to 20 Guidant engineers at a time worked on the ideas, too. They’d make a prototype, try it, reject it, refine it. Finally, in what Wilson calls Phase 3, they had it.

The bifurcated stent goes in on the end of one wire. The cardiologist snakes it to the site. Picture it, Wilson says, as a little Y-shaped device with its legs tied together. It reaches the site, helped by a balloon, the wire comes off, and the ankles unbound. It pops open, settled at the junction.

Eureka.

"The thing about this is it makes something that was so complicated so simple," Wilson said. "The beauty of this is it goes in over one wire. Only when it gets to the bifurcation are the ankles unbound."

Innovations in health care, like this one, are often dreamed up by people who are passionate, said Dana G. Mead Jr., president of Vascular Intervention at Guidant. Through the years of development, Guidant’s interest waned from time to time. But Wilson’s stayed true.

"He deserves a lot of credit for this coming forward," Mead said in a phone interview from his office in Santa Clara, Calif.

Guidant took the bifurcated stent into a clinical trial in Europe two years ago. In May 2002, Wilson watched by big screen with an audience at a Paris meeting as the first one was implanted in a patient in Rotterdam. In the trial, 105 patients got the stent, with followup by angiogram, as the company worked toward approval by the Conformite Europeenne Mark. The chief investigator was French interventional cardiologist Thierry Lefevre in Massy, France.

That trial time was a mental trial for Wilson, too.

"In this phase, I’m the nonparticipant," Wilson said. "A clinical trial is very secretive. Even from me. Even from Guidant."

The clinical results were presented at the Transcatheter Cardiovascular Therapeutics meetings in Washington, D.C., in September.

"It was terrific," Wilson said. "That was the end of a long period of no information."

The stent had a complication rate, called a MACE rate for major adverse cardiac events, of 2.9 percent in the hospital and within 30 days and 17.1 percent during 180 days. The complication rate is excellent, Wilson said.

"It’s already in use in the countries of Europe," he said. "And in Asia, and Australia and New Zealand. By now, it’s in thousands of people."

Carlos Duran, who leads the International Heart Institute as the chairman of the IHI Foundation board, is "absolutely delighted."

"Of course, I encouraged him completely," he said. "That’s what I want, a creative atmosphere where people say, ‘There has to be a better way.’ The basic idea of the institute is to encourage that."

"It’s a very slow process," said Duran, a cardiac surgeon and researcher and inventor himself. "You have to have a lot of patience. You have problems, and you have to work around them. That’s what he has been doing."

Wilson’s gift is his power of concentration, said Tim Engberg, vice president of cardiac services at St. Patrick Hospital, where the Heart Institute is based.

"It’s this simplicity of focus," he said. "There’s nothing else on the screen when he’s talking about it."

Most physicians who are involved in such innovations work at large medical centers and teaching hospitals in cities, said Mead of Guidant.

"Many of the meaningful developments come from the combination of physician inspiration, venture capital and engineering innovation," he said. "That’s not unusual. It is unusual for a physician in private practice in a location such as Dr. Wilson’s."

Guidant is in "very constructive discussions" with the FDA, working toward American approval, Mead said. Early plans call for developing the Multi-Link Frontier in a drug-eluting version for the United States. Drug-eluting stents are coated with drugs that inhibit the growth of scar tissue that would reblock an artery. About 80 percent of stents in use nationally are drug-eluting, Mead said.

"It gets physicians very excited when they hear about a drug-eluting bifurcated stent," Mead said. "It’s highly likely we’ll see it in that form down the road. Either Frontier or Son of Frontier."

Wilson will stay involved with the developments. He has some other ideas, too. He’s going to Warsaw, Poland, to watch Polish cardiologists put in one of the stents this week. One day, he may get to do so in his own patients in Missoula, where he has practiced since 1973 and is considered the grandfather of interventional cardiology.

When he started, the word "interventionalist" didn’t even exist, he said. The whole job is "pretty amazing."

"We can have somebody with crushing chest pain spend an hour in the cath lab with a Band-Aid on his groin, and the next day he can walk to the ‘M,’ " he said.

"As an interventionalist, I consider myself blessed to be lucky enough to be in the right time and the right place that handed me these wonderful tools that allow me to do magic. I get to be the magician."

Reporter Ginny Merriam can be reached at 523-5251 or [email protected]