Ulrich Sigwart is a cardiologist known for his pioneering role in the conception and clinical use of vascular stents. He also introduced a non-surgical intervention for the treatment of hypertrophic obstructive cardiomyopathy.
Biography
Sigwart was born in Wuppertal. His family has its origins in Tübingen where several members played an important role at the local university. Most of his ancestors were doctors, philosophers, or theologians, and a street in Tübingen is named after one of them. He had his medical education in Freiburg, Basel and Munster. After some years in the U.S. followed by additional training in Zurich he was charged in 1973 to set up an invasive cardiology program at the Gollwitzer-Meier Institute in Bad Oeynhausen in Germany, which became the nidus for the Heart and Diabetes Center North-Rhine Westphalia. From 1979 to 1989 he headed the section of invasive cardiology at the University Hospital in Lausanne. From 1989 to 2001 he was director of the department of invasive cardiology at the Royal Brompton Hospital in London and occupied the chair of cardiology at the University of Geneva until his retirement in 2006. Sigwart believed in the concept of intravascular scaffolding. In 1987, after several years of preliminary work in animals, he published a landmark paper on the use intravascular stents in humans to prevent occlusion and re-stenosis after angioplasty of coronary and peripheral arteries. In 1994 he introduced percutaneous alcohol septal ablation, a non-surgical method for the treatment of hypertrophic obstructive cardiomyopathy, which often allows symptomatic patients to avoid open heart surgery. During the years 1974–1978 he created the basis for the automated analysis of hemodynamic data and studied the repercussions of myocardial ischemia and the performance of artificial heart valves.
Ulrich Sigwart's place in the history of arterial stenting
Self expanding mesh stent Andreas Gruentzig had already recognized the problem of abrupt closure and restenosis after angioplasty. The need for a suitable form of intraluminal support in the hope of reducing or preventing this problem became obvious. Several investigators envisioned such devices during the first years of clinical application of angioplasty. Following reassuring animal work with self expanding mesh stents in Lausanne Sigwart reported the first human implants of such vascular scaffolds. These vascular stents, implanted in peripheral and coronary circulation, were multi-filament self-expanding, spring-like devices made of surgical steel. Sigwart's work made angioplasty predictable which significantly improved the outcome and offered a chance to overcome the problem of abrupt closure and recurrence. Sigwart's early stenting work received great interest and many travelled to Lausanne to observe the technique in practice. In a 1987 paper entitled ‘Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty’, Sigwart et al. gave an interesting account of the clinical use of stents to prevent occlusion and restenosis. Sigwart's work also provided him with an opportunity to observe the outcomes and indeed the shortcomings resulting from stent therapy. Very early after the launch of vascular stents Sigwart voiced caution regarding the purely mechanical support. One such case was that of a patient who, 3 months after implantation in the proximal left anterior descending artery, developed severe chest pain and angiography showed severe restenosis. Sigwart urged the surgeon to remove the stented segment and reported how ‘gazing at the massive tissue obstructing the stent lumen, the hypothesis of mechanical support for the prevention of restenosis looked like an illusion' and he suggested that a combination of mechanical and biologic factors would help to overcome the problem of recurrence. In 1989, Sigwart took up the directorship of the Department of Invasive Cardiology at the Royal Brompton Hospital in London, England, and during his 12-year tenure at this post, he initiated the first randomized study aimed at comparing percutaneous coronary intervention employing stents with the relatively well-accepted coronary bypass surgery.
