Mending broken hearts-Missoula cardiologist has gained international acclaim for his inventions

Stan Wilson is not a mechanical genius. His wife jokes that
he can’t even fix an alarm clock.

He hardly looks the part of a world-class inventor. His
free-form salt-and-pepper beard and easy manner make him
more likely to be taken as just another Missoula guy. And a
doctor? Hardly.

By GINNY MERRIAM of the Missoulian

But Wilson is a heart doctor, known to colleagues as the
grandfather of interventional cardiology in Missoula and
beloved by his patients. He’s president of his practice, and
he’s on the working panel of physicians at the International
Heart Institute of Montana. And he has earned international
attention recently for an invention that appears to have
solved a frustrating problem in cardiology and stands to
improve outcomes for millions of patients with blocked
arteries.

On May 22, Wilson sat with about 5,000 other cardiologists
in Paris and watched on a monitor as doctors in Rotterdam
implanted the invention in a 79-year-old man. The pioneering
stent is meant to support the man’s diseased coronary
arteries in one of the most difficult areas to treat. The result
has been elegant.

He wasn’t nervous at all, Wilson jokes. And he didn’t enjoy
the sole-and-champagne dinner afterwards. The event was
the end of six years of work.

Along the way, Wilson has picked up nine patents for his ideas. A plaque for each hangs on the wall
of the offices at Cardiopulmonary Associates of Missoula. Five or 10 more are coming.

The last six years, he says, have been a fun trip. He feels lucky. And blessed.

"I’m fascinated with how did this happen to me," he said. "It’s not that I’m some sort of special
person. This could have happened to any one of thousands of interventional cardiologists who have
engineering or mechanical background. I just stumbled into an idea. And the idea became another
idea. And a new way of thinking turned out to have rewards."

The 60-year-old Wilson has been solving problems of the heart in Missoula since 1973. After medical
school at Johns Hopkins University and during cardiology training at the University of Colorado at
Denver, he discovered the mountains of Missoula one beautiful May. This was the place, he said.

Missoula had two cardiologists, Hal Braun and Jerry Diettert. But it had no heart catheterization lab,
where cardiologists can intervene in the heart and its systems to mend the damage of disease. He’d
have to start one. When Wilson came to Missoula a year before the end of his training to pitch the
idea, the administrator of St. Patrick Hospital at the time was leery. But he came around after Wilson
found interest at Community Medical Center, where a new hospital was going up.

In 1979 in Zurich, doctors performed the first angioplasty, in which they inflate a balloon inside a
clogged artery to reopen it and restore the flow of oxygen-rich blood. In 1982, Missoula’s cath lab
started an angioplasty program.

"We have been pioneers in doing angioplasty," Wilson said. "We have been pushing the envelope of
technology."

In 1994, American cardiologists began using the revolutionary technology called stenting. A stent is a
tiny stainless steel tube put in place to hold open a damaged, clogged artery that needs the extra
help but where a surgical bypass is not called for.

Interventional cardiologists begin with an incision at the patient’s groin and snake the stent up
through the cardiovascular system to its final position. The patient’s own tissues grow and
incorporate the stent in four to six weeks.

The results can be magic, Wilson said, even for a patient who can’t walk across a room without chest
pain.

"The next day," he said, "they can walk to the ‘M.’ "

In many cases, a stent can last longer, without more attention, than an angioplasty.

"They make much better outcomes," Wilson said. "They’re much more reliable and longer lasting.
We like to stent anything we can stent. That’s the best treatment."

As stent technology moved forward, a central problem emerged: How do you solve a blockage
problem at the point where arteries branch? Because of the turbulence of rushing blood, the junction,
called a bifurcation, can be a point of disease. A stent on each branch leaves the junction
unprotected. A stent at the branch could block one of the branches. What sort of device could solve
the problem at the fork? And how would that device get there?

"It became clear to everybody putting stents in that we needed to solve the problem of bifurcation,"
Wilson said. "Our mission statement as interventional cardiologists is to provide a solution. And our
mission is to provide the least invasive solution."

At least 20 percent of the patients treated for coronary artery disease have lesions in a bifurcated
area. In 1994 and ’95 at annual cardiology meetings Wilson attended, half-day sessions would
engage the best heart minds in looking for a solution to bifurcations.

"It always seemed like next year, we’d have the answer," Wilson said. "But every meeting was the
same. Nobody was able to solve this problem."

Wilson had been on the advisory board of Guidant Corp., an Indianapolis-based international
company that develops technology to treat cardiovascular disease, for a decade. Guidant officials
were very interested in a solution, as were their three or four competitors.

Wilson began to turn his brain.

"Early in ’96, I just gave myself permission to think about it," he said. " ‘There’s got to be a solution.’
And I’m not an engineer. But you don’t have to be an engineer to invent a mousetrap."

Once Wilson began thinking, he also began observing his own creative process. He imagines it as
one of the first computers, the kind that took up whole rooms and shuffled punchcards all day,
working until the holes lined up.

Even when Wilson was thinking of something else, those cards were running somewhere in his brain.
Shuffling, shuffling, shuffling while Wilson was driving to work, going to sleep, talking with his wife,
Donna, but not listening.

Some of his biggest inspirations came when he least expected them.

One visited after he had been up all night with a sick patient, then worked all the next day. That night,
he finally got to bed at 11 p.m.

"I was exhausted," he said. "Too tired to think. Seconds from hitting the pillow. And there it was:
‘That’s it!’ My wife doesn’t remember this because she was asleep. I got up and wrote it down."

Another inspiration came under similar pressure. Wilson was worrying about five or six patients for
whom no solutions were apparent.

"I had been back and forth to the hospital with these air ambulance people coming in with the most
complicated possible problems," he said.

He was an hour and a half behind in seeing patients, who were jammed up in the waiting room. It was
snowing. As he was crossing the street from the hospital to his office, trying not to fall, it happened:
an answer.

Wilson took his ideas to Guidant officials in mid-summer of 1996, expecting them to say, ‘Thanks,
but we’ve got our own ideas." They embraced him, and that was the beginning of the effort.

In the past six years, two to 20 Guidant engineers have been working on the ideas at any given time.
Wilson was too. Ideas would lead to bench models and prototypes tried in pigs. Wilson divides the
time into Phase 1 and Phase 2.

"We got prototypes that worked, but they didn’t work well enough," Wilson said. "It would look like it
was going to work, and then this was a dead end. But we learned some critical things. … So there
was a Phase 2."

Through this time, Wilson couldn’t talk to anybody about it. Even now, much of the detail is
"proprietarily inappropriate."

Finally, Wilson and the engineers took the best of the two phases and put them together.

"We created Phase 3," he said. "And Phase 3 is what the world is going to see."

The bifurcated stent has to orient longitudinally and radially from a point at least 100 centimeters
away, in the groin. It has to be 2.5 to 4 millimeters across. Picture it, Wilson said, as a little device
with two legs bound at the ankles. It goes in to the site, a balloon inflates to help, the cardiologist
puts it in place. The wire comes off, and the ankles are released.

Eureka.

"If you look at it, you say, ‘Well, that’s simple enough,’ " he said. "And it is simple. But you had to
sort of find your way there. How many times have I thought, ‘It ain’t gonna work’?"

Guidant and Wilson arranged a licensing agreement. The company will manufacture the device and
do the clinical trials, first in Europe. Wilson hopes for a clinical trial in the United States soon.

People are excited about this, not the least of them Wilson’s colleagues and friends at the
International Heart Institute of Montana based at St. Patrick Hospital. Even before the patents,
Wilson was an innovative thinker, said Tim Engberg, vice president for cardiac services at St. Pat’s.

"Stan has been innovating and inventing for a long time," Engberg said. "It’s the ability to really look
at a situation or a technology from a different perspective."

Wilson is not just a linear thinker, Engberg said. He’s able to turn ideas on their ears and find
solutions.

"It’s the ability to look at a situation or a technology from a different perspective," he said.

And, he said, "His dedication is 24/7. He’s thinking about it all the time."

Heart Institute president Carlos Duran has been a great supporter, Wilson said.

"He is thrilled for me," Wilson said. "He loves this process by which you try, fail, learn, try again."

Wilson will be financially rewarded, generously no doubt. But what he really wants to do is keep
working with his patients and keep inventing – he has some more ideas.

He can hardly wait to see the bifurcated stent – Guidant named it the Multi-Link Frontier Coronary
Stent System – start helping patients. Not a week goes by that every cardiologist has patients with
poor outcomes, patients who have to have repeated procedures because the technology is missing.
That bothers Wilson.

"If I’m remembered for anything, I’d like it to be remembered that I cared," he said. "And that gets you
everywhere."

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

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