CardiovascularspecialistZhouYujie(thirdright,front)isconsideredapioneerandcentralfigureinpromotingtransradialangioplastyandinterventioninChina.ZhouandhisteamfurtherexpandedarterialaccessforPCIfromthefemoralarterytoseveralradialarteriesontheupperarm,providingmore“avenues”fortreatinghundredsofmillionsofcardiovascularpatientsintheworld’slargestdevelopingcountry.byDongFangPercutaneouscoronaryintervention(PCI),alsoknownascoronaryangioplasty,isoneofthemostrevolutionarytechnicalbreakthroughsfortreatingcardiovasculardiseasesinrecentmedicinehistory.In1992,DutchcardiologistFerdinandKiemeneijsuccessfullyperformedtheworld’sfirsttransradialangioplastyandstenting.Despitethetwistsandturnsduringitsglobaldispersal,thiscoronarytreatmentmethodresultedinfewercomplicationsandalowermortalityrate,leadingtouniversalacceptance.
ZhouYujie,acardiovascularspecialistandvicepresidentofBeijingAnzhenHospital,isconsideredapioneerandcentralfigureinpromotingtransradialangioplastyandinterventioninChina.HefoundedanInternationalTransradialCardiovascularInterventionandTreatmentCenteratBeijingAnzhenHospitalandledhisteamincarryingoutthefirstlarge-scaleclinicalpracticeandtraininginChinainthisfield.TheireffortshavegivenChinathehighestpenetrationrateoftransradialinterventionintheworld.
Manyyearsago,ZhouYujieoncedemonstratedatransradialangioplastyalongsideProfessorKiemeneij.Atthattime,theyreceivedpushbackandcriticismfromsomeoftheirwatchingcounterparts.Butthisdidn’tabateProfessorKiemeneij’sconfidencefortheprospectsofPCI,nordiditZhou’s.Althoughdubbeda“madmanoftransradialintervention,”Zhoumaintainsthattheonlygoalofmedicalinnovationistotreatdiseasesatthelowestcostandwithminimalpaintopatients.
ClearingVeinsforLife
Throughouthisdecades-longmedicalcareer,Zhouhasbeenprimarilyengagedininterventionaltreatmentofcardiovasculardiseases.PCIisoneofthefastestgrowingandmostactivesubfieldsintherealmofcardiology.Itinvolvestransradialcatheterizationwiththehelpofmedicalimagingtechniques.However,notuntiltheendofthe20thcenturydidChinesecardiovascularprofessionalsbeginpayingattentiontotransradialaccessforinterventionaltreatment.Mostchosethefemoralarterytoperformcatheterization.Afterreviewingmanysuchcases,Zhourealizedthatthetransfemoralprocedurefrequentlyresultedinseverebleedingandcorrespondingcomplications.“Aftersuchasurgery,thepatienthastolayflatonabedforadozenhours,andthedoctormustexertcontinuedpressureonthewoundtostopthebleedingforfourtosixhoursbeforeremovingthearterialsheath,”heexplains.“Thisisanexhaustingprocessforbothpatientanddoctor.”
Duetoitsloftyreputationincardiovasculardiseasetreatment,BeijingAnzhenHospitalisperpetuallycrowdedwithpatientsfromacrossChina.Typically,physiciansinitsCardiologyDepartmentperformadozensurgeriesaday.Whenhewasdirectorofthedepartment’sWard12,Zhouoftensleptonacouchinhisofficebecauseheneededtoremovearterialsheathesforpatientswhofinishedsurgeriesinthedaythroughouttheweehours.Sometimesheandhiscolleagueshadtotreatpostoperativecomplicationssuchasedemaandhemorrhagicshock.
Inthiscontext,Zhouwaseagertofindasaferprocedurethatwouldcauselesspaintopatients.Around2000,henoticedthatsomeofhisEuropeanandJapanesecounterpartsbegantoapplytransradialintervention.ButZhoudidn’tfindachancetotrythistechniqueuntilMay2002whenapatientwithangiitisfromZaozhuang,ShandongProvince,askedhimtoperformatransradialangioplastyfromthearm.WhileonatraintoZaozhuang,ZhoustudiedabookonthelatestadvancesreportedataEuropeaninterventionalcardiologyconferenceandimaginedallpossibleoutcomesoftheangioplastyoverandover.
Atthetime,localhospitalsinZaozhuanglackedspecializedtransradialpunctureinstruments,soZhoumanagedtoplacetwostentsinablockedbloodvesselwithconventionalcatheters.Thiswasthefirsttransradialinterventioneverperformedinalocalhospital,whichattractedatelevisionstationtocoverthesurgery.Lessthantwohoursaftertheoperation,thepatientcouldalreadyusehisarmthathadbeenusedintreatmentwhiletakingashower.Transradialinterventionhasobviousadvantages:Postoperativebleedingcanbestoppedpromptlyandconveniently,andpatientsneednotrestonabedforadozenhours.Clearly,theysufferlesspainandrecovermorerapidly.Moreover,transradialinterventionisusuallyaccompaniedbyfewercomplicationssuchasbleeding,andpatientscanleavethehospitalsoonerwithasmallerbill.Forthisreason,Zhoubelievesthatthistreatmentmethodshouldbecomemainstreamforthemajorityofcardiovascularpatients.
Afterwards,Zhouandhisteambecamedevotedtoclinicalpracticeandresearchoftransradialangioplasty.Zhoudividedtheireffortsintothreestages:Thefirstwasaboutappliedresearchincludingsurgicaltechniquestoavoidvariouscomplications;thesecondstagefocusedonexpandingtheavailabilityofradialaccessandexploringthepossibilitiesoftheulnarandbrachialarteriesasaccessforinterventionaltreatment,aswellassolutionstorelevantproblems;thethirdstageplacedpriorityonbloodvesselprotection,duringwhichtimetheyconductedresearchonvasculartraumaandreapplicationintransradialintervention.
“Foratime,manycalledmea‘madmanininterventionaltreatment’becauseIgaveuponthefemoralarterywithadiameterofsixmillimetersinfavoroftheradialarteryasnarrowaslessthantwomillimeters,”Zhouexplains.Morethantwodecadesofclinicalresearchandpracticehasshownthattransradialinterventionnotonlyeliminatestheneedtolieflatforadozenhoursaftertheoperation,butalsocutsthemortalityrateby28percentandthepossibilityofseverebleedingcomplicationsby23percent.
Afteryearsofapplicationandpopularization,transradialinterventionisnowusedtotreatnotonlyminorcardiovascularailmentsbutalsocomplicated,dangerousdiseases.Theestablishmentofatransradialinterventionsystemhasnotonlyresultedinrational,effectiveuseofmedicalresources,butalsocreatedtremendouseconomicandsocialreturns.Itisestimatedthatasingletransradialinterventionsurgerycansaveatleast8,000yuancomparedtoatransfemoralinterventionsurgery.In2016,morethan1.2milliontransradialinterventionoperationswereperformedinChina,whichwereestimatedtohavesavedabout10billionyuan.
AsoneoftheglobalchampionsofminimallyinvasivePCI,Zhouhasnotonlyledhisteamtodelveintoresearchofthisnewinterventionaltherapy,butalsodevotedhimselftopromotingtrainingonthetechniquebothathomeandabroad.HepublishedthebookTransradialCoronaryAngiographyandInterventiontospreadknowledgeonthetreatmentapproach.Inaddition,hehasorganizedtheInternationalForumonTransradialCardiovascularInterventionfor11yearsstraightandhassharedcasesandexperiencesatnumerousinternationalacademicconferences.ThankstoZhouandhiscounterpartsbothathomeandabroad,in2012,theClinicalPracticeGuidelinesoftheEuropeanSocietyofCardiologylistedtheradialarteryastheprimeaccessforPCItreatment.Thepopularityrateoftransradialinterventionhasrisenfromlessthan5percentto90.5percentinChina.
Overtheyears,theprevalenceandmortalityratesofcardiovasculardiseaseshavebeenontheriseinChina.Accordingtothe2018ReportonCardiovascularDiseasesinChinareleasedbytheNationalCenterofCardiovascularDiseasesofChina,morethan290millionpeoplearesufferingvariouscardiovasculardiseasesinthecountry,whichcontributeto40percentofdeaths,afigurehigherthananyotherdisease.Interventionaltreatmentiskeytorescuingpatientsfromacuteandseverecardiovasculardiseases.
ZhouandhisteamfurtherexpandedarterialaccessforPCIfromthefemoralarterytoseveralradialarteriesontheupperarm,providingmore“avenues”fortreatinghundredsofmillionsofcardiovascularpatientsintheworld’slargestdevelopingcountry.Thisbreakthroughhasglobalsignificance.ProfessorKiemeneij,whowasdubbedthe“FatherofTransradialIntervention”globally,calledZhouthe“Chinesepioneerintransradialinterventionpractice,”notingthattheresearchteamatBeijingAnzhenHospitalheadedbyProfessorZhouYujiegreatlyboostedthedevelopmentofminimallyinvasiveinterventionaltreatmentinChinaandbecameashiningglobalrepresentativeforminimallyinvasivecoronaryintervention.
ZhouYujie(left)demonstratesatransradialinterventionsurgeryalongsideDutchcardiologistFerdinandKiemeneij(right),whosuccessfullyperformedtheworld’sfirsttransradialangioplasty,atBeijingAnzhenHospital.
ZhouYujie(right)andProfessorFerdinandKiemeneijattendthe2010InternationalForumonTransradialCardiovascularIntervention,atwhichProfessorKiemeneijpresentedmedicalrecordsontheworld’sfirst100transradialinterventionsurgeriestoZhou.WhenZhouYujie(firstleft)seespatients,hisPh.D.studentBrightEricKing(secondleft)fromGhanaoftenwatches.Zhouhopesthathisforeignstudentsfromdevelopingcountriescanbringadvancedmedicaltechniquestotheirhomestohelpmorepeople.State-of-the-ArtTechniquesforAll
Whentransradialinterventionwasfirstappliedinclinicalpractice,manyofZhou’scounterpartsfrombothChinaandoverseasarguedthatitsextremedifficultywouldmaketheapproachlesspractical.Indeed,comparedtothefemoralartery,theradialarteryfeaturesamuchsmallerdiameter,whichmakesithardtobepuncturedandeasiertocauseproblemssuchasspasm,twistedarteries,variationsandstenosisduringtransradialinterventionsurgeries.Inthiscontext,howisthesuccessrateoftransradialinterventionguaranteedacrossthemedicalcommunity?
Zhouisconfidentbecausehebelievesinhisstate-of-thearttechniques.Overdecades,hehascompleted15,000proceduresofcoronaryangiographyandintervention.Hisrichclinicalexperiencehasbestowedonhimsuperbmedicalskills.
“Medicineisanappliedscience,”Zhouoftentellshisstudents.“Andinmostcases,itisanirreversibleartwiththemediaoflife.Inasurgicalroom,adoctorneedstocontrolhimselforherselfwithexperienceandtechniquestosolveproblemsandsavelives.Wemustperformthesurgeriesthatotherscannotandgivebetterperformancesthanotherscan.”
InDecember2013,apatientwithtachycardiacametoZhou.Thepatientwasfallingintotachycardiaseveraltimesaweekandalmosteverytime,hewenttotheemergencyroom.HehadalreadyreceivedsurgeriesattwohospitalsinBeijing,butphysicianshadabortedtheoperationshalfwayduetocardiacperforation.AfterthepatientwasadmittedtoBeijingAnzhenHospital,Zhouandhiscolleaguesagreedtoarrangeasurgery.
Duringthesurgery,Zhoufoundthesituationmorecomplicatedthanheexpected:Thepatienthadanabnormalcardiacstructure,andtherewasalesionhiddendeepinacornerofhisheart,unreachablewithconventionalsurgicalapproaches.Aftertwohoursofsurgery,therewasnoprogress.However,Zhoustilldidn’tgiveup.
Thepatientcamefromalow-incomefamilyinsuburbanBeijing.Previoussurgeriesandtheemergencytreatmentcostshadalreadyimposedaheavyfinancialburdenonhisfamily.Zhouwasunwaveringinhiscommitmenttohelpthepatient.“Fortunately,nocomplicationsoccurredduringthesurgery,”herecalls.“Idecidedtotrymybesttotreatthepatient.”Aturningpointfinallyarrivedinthesurgery’sthirdhour.Throughperformingaradiofrequencyablation,Zhousuccessfullyremovedthedysfunctionaltissuethatwascausingthepatient’stachycardia,andheneverexperiencedtheconditionagain.
Zhouoftenparticipatesinemergencytreatmentwhenhecan.Ataround9p.m.onApril30,2017,Zhoureceivedaphonecalljustbeforehearrivedhome,inwhichhewasinformedthatapatientwithacutemyocardialinfarctionwasinemergencytreatmentandcouldusehishelp.AsZhourushedbacktotheemergencyroom,thepatient’sheartstopped.Doctorsintheemergencydepartmentdidalltheycould,butnothingworked.Thepatient’srelativesimploreddoctorstokeeptryingtosavehislife.
Uponarrival,Zhouandhiscolleaguescontinuedemergencytreatmentforanotheroneandhalfhours,butwithoutapositiveresponsefromthepatient.
Bytheweehoursofthenextday,morethanthreehourshadpassedsincetheonsetofthestroke.Attherequestofthepatient’sfamily,Zhoumadeariskydecision:Hecheckedcirculationinthecoronaryarteryofthepatientwhohadbeendeclaredclinicallydead.Atransradialcoronaryangiographyshowedthatthethreeblood-supplyingvesselsinthepatient’sheartwereallblocked.Zhouimmediatelyplacedtwostentsinoneofthethreebloodvesselsthathadclearlyjustbeenblocked,whichrestoredcirculation.Fourhoursafterhisheartbeathadstopped,thepatient’sheartstartedbeatingagain.Then,afteraseriesoftreatments,thepatientopenedhiseyesby11a.m.thenextday.
Zhouandhiscolleagueslatersummarizedthefactorsbehindthemiracle:timelyhospitalization,professionalcardiacmassage,firstclassemergencytreatmentandpostoperativenursing,trustfromthepatient’srelatives,boldandeffectivemeasurestakenbydoctors,andthespiritofnevergivingup.Themiraclewouldhavenothappenedifanyofthesefactorshadnotbeenpresent.
Themarvelousemergencytreatmentalsostunnedtheworld.Beforethat,nopatientwithaheartbeatstoppingforsolonghadeverbeenrevived.AninternationalclinicalresearchconferenceawardedZhouandhisteamfirstprize,andtheawardpresentationwordsread:“Lifeisfragile,butmiracleshappenwhendoctorsdonotgiveup.”
AsoneofChina’smostprestigiouscardiologyhospitals,BeijingAnzhenHospitalhasreceivedcountlesspatientswithcomplicatedheartdiseases.Duetohisoutstandingskill,Zhoualwaysplaysacentralroleintreatingthesepatients.Healsoconsistentlymakesbreakthroughsinclinicalresearchonrarercases.
InhisContrastAgents:AKnottyProblemforCoronaryIntervention,Zhouprovidesasystematicanalysisoftheimpactofcontrastagentsusedincoronaryinterventiononthekidneys.Heeverperformedsurgeriesonapatientwithanacutemyocardialinfarctionwhohadatransplantedkidney.Duringthesurgeries,Zhoumeticulouslycontrolledtheamountofcontrastagentsandusedlessthanhalfofthenormalleveltocompletetheimagingtoavoidinjuringthepatient’stransplantedkidney.
Zhouhasbeenapplaudedforhiseffortsinpromotingtransradialinterventionintheinternationalcardiovascularcircles.However,heandhisteamaimhigher:Theywanttoexploremoreworld-leadingcardiactherapies.Someofhisteamfocusontheresearchofsystematicdiseasessuchasmetabolismproblemsoftheheartandthekidneysplaguingmanyseniors,andotherscommittobiomedicalresearchsuchasnanomedicineandmedicalnanorobots.Inthecomingdecade,Zhouwillbeginpromotingtheapplicationofmedicalrobotsinperipheralcardiovascularsurgeriesandexploringdomesticlasertherapiesforvascularcalcificationtoremoveimpuritiesfromthebloodandpreventcardiovasculardiseasesatcostscomparabletothepriceofacellphone.
SpiritofaGreatDoctor
Whenapplyingforcolleges,Zhouwentagainsthisparents’adviceandchoseHarbinMedicalUniversity.Once,heandseveralofhisclassmatesvolunteeredtotransportbooksfortheiruniversity’slibrary,whichtookseveraldaysofhardwork.Asarewardforhisdedication,thechieflibrarianletZhouchooseabooktokeep.ZhouthoughtforawhilebeforeselectingacopyofAppliedCardiology,atextbookcompiledbyChinesetrailblazersincardiologyDongChenglangandTaoShouqi.ThisbookkindledZhou’slife-longloveaffairwithcardiology.Overthefollowingthreedecades,ZhoubecamefriendswithseveralpioneeringChinesecardiologists,fromwhomhelearnedalot.
WhenZhoujoinedapostgraduateprogram,ProfessorTaoShouqivisitedHarbintolecture.HistutoraskedZhoutoaccompanytheprestigiouscardiologist.Overthenextfewdays,ZhouescortedProfessorTaotovariousactivitiesduringthedayandsleptintheouterroomoftheprofessor’ssuiteatnight.
“Iworealinenshirt,atieandapairofleathersandals,”Zhourecalls.“Onarainyday,IheldanumbrellaforProfessorTaowhenheattendedanoutdoorevent.Movedbymyhospitality,hepredictedIwouldbecomesomebodyonedayandremindedmethatifIattendedaninternationalconferenceinthefuture,Ishoulddressbetter,notingthatthetiedidn’tmatchthewrinkledshort-sleevedlinenshirtorapairofcasualsandals.”
JustasTaopredicted,todayZhouisaspecialistofglobalfameinthefieldofPCI.Heoftenspeaksatinternationalacademicconferences.Evenonordinaryworkingdays,heusuallywearsalong-sleevedwhiteshirtandatie.“ThisremindsmeI’mamedicalprofessionalandneedtocontinuestudyingandseekinginnovation.”
DuringapostdoctoralprogramatBeijingMedicalUniversity(nowPekingUniversityHealthScienceCenter),ZhouwastutoredbyProfessorWangLihui,aChinesepioneerininterventionalcardiology.Atthetime,ProfessorWang’shealthwasfailingduetooldage.Evenso,sheoftentaughtZhouwhilewearingacotton-paddedcoatandsittingonasickbedpackedwithbooks.SheexhortedZhoutostaycalmanddevotehimselftomedicalresearch.
Inthepast,whenlecturingelsewhere,ZhouoftenbroughtaheartspecimendonatedbyWuYingkai,thefoundingpresidentofBeijingAnzhenHospital.BeforeestablishingBeijingAnzhenHospital,WuservedaspresidentofFuwaiHospitalundertheChineseAcademyofMedicalSciences.
WucoinedBeijingAnzhenHospital’smottoof“Equity,Diligence,PrecisionandHonesty”andpledgedtodonateallofhisorganstomedicalresearchandteachinguponhisdeath.
Throughwordsanddeeds,thoseseniormedicalexpertsinspiredZhoutopreserveandspreadthespiritofagreatdoctorthroughtheirdedication,selflessnessandcommitmenttohelpingeverypatientwiththemostadvancedmedicaltechniques.Zhoucannotcountthetownshehasvisitedtodosurgeries.HisfootprintscanbefoundinalmosteveryChinesehospitalthathasintroducedPCI.
In2012,withZhou’ssupport,severaldoctorsfromBeijingAnzhenHospitalparticipatedinamedicalaidmissionintheRepublicofGuineainAfrica,wheretheysharedtheirexperienceinPCIwithlocaldoctors.In2016,BrightEricKing,aPh.D.incardiovasologyfromGhana,becamehisstudent.Zhouhopesthathisforeignstudentsfromdevelopingcountriescanbringadvancedmedicaltechniquestotheirhomestohelpmorepeople.
Intheeyesofhisstudents,Zhouisa“superman”andastrictteacher.Inadditiontosuperbmedicalskills,Zhouisalsonotedforhisphotographicmemory,studiousspiritandfluentEnglish.Thelastthinghecanbeexpectedtodoistowastetime.“Timeismorepreciousthangold,”hesays.“Withmoretime,Icouldsavemorelivesorlearnmoretobetterhelppatients.”
AlmosteverydayZhoucarriesabagloadedwithvariouselectronicdevicesthatconnecthimtotheinternet.Beforesmartphoneswereeverywhere,heequippedeachofhisstudentswithamobilehotspot,sothattheycould“accesstheworld”viatheinternetanytime.Everytimeheencountereddifficultcases,Zhouwouldsearchtheinternetforthelatesttechniquesintreatingsimilarcases.Heinstructshisstudentsandyoungerphysicianstodothesame.“Beforecheckingyourpatients,youneedtobefamiliarwithallrelevantinformationfromsimilarcasesfromaroundtheworld,”heexplains.
Zhoutaughthisstudentsthreemajorlessons:todreamofbeingagreatdoctor,tomaintainaspiritofdiligenceanddedication,andtogaintheabilitytoresistvariousdistractions.Thesearewhatfueledhisdecades-longcareer.
ZhouYujieoftenencouragesstudentsanddoctorstoparticipateinmedicalaidmissionsabroad.ThispictureshowshispostdoctoralstudentLiuXiaoli(center)providingepidemicsurveytrainingtolocalmedicalworkersduringamedicalaidmissiontofightEbolaintheRepublicofGuineainAfrica.