Intervention cardiologist at the Temple University School of Medicine, Srinagar-born Prof Riyaz Bashir has devised a special series of life-saving, clot-removing catheters, some of which have already got FDA approval. In November, he was honoured by the Cardiovascular Research Foundation for his devices, which were termed as one of the four “most promising technologies”. Named after him, as Bashir Cardiovascular Catheters, these were developed at an investment of US $17 million (Rs 140 crore), he told Masood Hussain in a detailed interview:
KASHMIR LIFE (KL): Science sees the brain as the controller of the body but literature focuses more on the heart. As a cardiologist, how do you see this dichotomy?
DR RIYAZ BASHIR (DRB): This question reminds me of Dr J Willis Hurst, who was a cardiologist at Emory University in Atlanta. He has written two main books on medicine and heart about cardiology. Towards the end of his career, he also wrote a small book named The Real Heart. So, as far as medicine is concerned, we take the heart as a siphon, a pump. But the philosophical literature mentions the heart and, I believe they refer to the real heart and the emotions related to it. We see it as a human heart and they take it as the heart of the soul.
KL: How has your expedition from Kashmir to Philadelphia been?
DRB: It was just a routine to fly out for advanced training after completing the course here. My teachers advised me to go for further training in America. Then I met Dr Farooq Khan in Srinagar and he selected me for the training in New York. So, I did my residency training in New York and then I did two fellowships, one in Boston and the other in Rochester, Minnesota. Later, I went to practice at Temple University of Medicine in Philadelphia in 2008 and most of my career has been devoted there only.
The main focus of my work was on blood clots and how we can dissolve and remove this thrombus from the vascular system. These clots cause a lot of problems in the patient’s body and, in certain cases, are even life-threatening. Thus far, there have been many experiments going on for many years to manage this issue but the available treatments were not quite effective.
When I researched this matter in depth and kept thinking about the effective way to eradicate this, I devised a way out. One day, at a conference, I came in contact with Mr Marvin Woodall who has served as a President of Johnson and Johnson interventional systems for 37 years. He is credited for inventing the first original Palmaz-Schatz Coronary Stent, which was termed “the most important new medical device in the past 15 years.” In 1995, he also initiated the original drug-eluting stent known as the Cipher stent including the Aortic valve repair and replacement.
So, I briefed him about the issue and solicited an effective way to dissolve the blood clots. He suggested some engineers that could figure out how to manufacture the tool. Some engineers refused to develop it as it was seen as inept for some reason.
Ultimately one of the engineers agreed to design the tool because he was himself suffering from such type of blood condition and had also lost a friend to it. So, with all the engineering and creative processes, it took us a year to finally produce the prototype of the tool.
We also have a heart association meeting where we have an innovation challenge and competition on new ideas and devices. Our tool won the very first prize in 2016 and because of that, it got an introduction in the medical equipment industry. We further tested the efficiency of the tool through experiments on animals and later on in humans as well. When it emerged with fully effective results then we submitted it to the (FDA) Food and Drug Administration. The FDA then approved the device for medical purposes in humans.
KL: This device is known as the Bashir Endovascular Catheter device. How many people have used it?
DRB: Up till now, more than 300 patients have utilized it. The device can be operated from two sides, either through veins or through the arteries of the lungs. But to this day, its approval is only to be used in veins. We are processing it through clinical trials and soon it will be approved for the arteries of the lungs as well. We expect that after the approval it will be used in a wider range as it is a life-saving device for clots.
KL: Is the device being used in America only or in other places as well?
DRB: So far, it is exclusively used in America because we have not expanded it to merchandise over the globe.
KL: Did the tool replace some existing device or is it a completely new one?
DRB: It can be considered as an improvisation of an existing device but it is completely a new concept. All the devices that we had before were made for smaller veins and arteries. But the arteries of the lungs are much bigger. We used to introduce 2mm catheter into a 30mm vessel, expecting that it will clean the vessel, but unfortunately, used not to work. Therefore, the catheter that I have innovated is made accordingly and as per the size of large vessels, so that when a blood clot occurs in a large vessel, it can be utilized in place of the small catheters.
KL: It is a life-saving device so did it require a lot of investment?
DRB: We did not require any venture capital fund because most of the investment in this device was made by private investors. Our CEOs and CFOs have themselves done enough investments because they believe in the technology and the asset. The biggest source of funding, however, was made by the federal government and the Commonwealth of Pennsylvania. They have provided US $5 million so far for the development of the device. But as a whole, it took US $17 million dollars for the device to reach the stage where FDA approved it for use. It actually is a basket of seven devices of which five are designed for the legs and two are designed for the lungs.
KL: Some cardiologists believe that most of the research remains restricted to the heart only and not to the lungs which are also part of the circulatory system. Is this correct?
DRB: Unfortunately, the number one cause of death worldwide is usually a heart or coronary disease and blockages that lead to cardiac arrest. The second cause of cardiovascular death is stroke and number three is a blood clot in the lung. So, over the last 50 years, we have focused a lot of attention on the heart arteries as it has been the major cause of death. Science has achieved remarkable success in this regard.
Since 2015, we have had tremendous success with stroke as well. The next frontier is on blood clots in the lungs and that is what I have focused on in my research career.
KL: Do you enjoy improvising things that you have already created or do you spend most of your time in the laboratory or in treating patients?
DRB: Around ninety per cent of my time is devoted to treating patients. But I do spend quite a bit of time in clinical research. We have a research and development team and I usually guide and advise them regarding certain aspects of clinical settings.
KL: What is the biggest challenge to medical science research as yet?
DRB: I believe the medical field has reached a stage where we can modify genes, and by gene editing, we can create certain opportunities that might be helpful in a broader way. The diseases and disorders that we weren’t able to cure earlier can now be easily treated and managed.
I believe, in the next 10 years, medicine will be completely revolutionized because of genetic testing, engineering, and technologies that have evolved. I will give you an instance. There was a patient who suffered from a disease known as sickle cell disease and she went through the genetic engineering process. Because of the gene editing, she does not have sickle cell anymore and is cured.
So, such an invention is a big deal and a game changer for us. We believe that in the future these technologies may also be able to cure cancer and heart diseases and treat other psychological disorders in quite an effective way. The mRNA Vaccine for Covid19 was also a miracle and was created in such a short period.
I am very optimistic that we are going to find some miraculous treatments in the next 10 years that will not only benefit the cardiovascular system and other diseases but also those of which we are not even aware yet.
Umaima Rishi processed the interview