One day last summer, in the pleasant village of Gig Harbor, Wash., John Zalman began to feel sharp pains in his upper stomach. By the next afternoon, “the pain got so intense, I asked my wife to drive me to the emergency room,” the 66-year-old says. There they received a startling diagnosis: one coronary artery completely blocked and another closing up fast.

The blockages put Zalman dangerously close to a serious heart attack and doctors recommended immediate action. He had two options: undergo open-heart surgery or have a stent inserted. The tiny device was patented in San Antonio.

Blocked arteries like Zalman’s are the main sign of coronary heart disease, the leading cause of death in the United States. The coronary arteries (also known as coronaries) sometimes become clogged with plaque, a term for the collection of fats, cholesterol and calcium that crowds out the normal flow of blood. Deprived of blood and oxygen, the heart muscle sustains damage and can begin to die—a heart attack.

While improvements to diet and exercise, coupled with medication, can sometimes prevent or mitigate chronically clogged arteries, the treatment of sudden clots continues to vex cardiologists.

Prior to the 1960s, there was little a physician could do for a patient with a bum ticker. In the mid-’60s, doctors began to perform invasive bypass surgeries, major operations in which another vein was grafted onto the blocked artery before the blockage and reattached to the same artery after the blockage, allowing the blood to flow around the plaque instead of struggling though it.

However, open-heart surgery carried multiple risks including infection, organ failure, heart issues, sustained chest pain and fever, and impaired cognitive function. It included a multi-day stay at the hospital in addition to a lengthy home recovery and was expensive, sometimes cost prohibitive.

In 1977, Dr. Andreas Gruentzig performed the first balloon angioplasty, a much gentler way to open up a blocked vessel using a balloon-tipped catheter. The catheter, inserted in the groin or arm, threads its way through the cardiovascular system until it reaches the clotted area, where the balloon is then expanded, opening up the clogged artery by compressing the plaque-ridden tissue into the sides of the vessel. But once the balloon was removed, there was a 30- to 50-percent chance the vessel would become blocked in the same place all over again, referred to as restenosis. Another significant risk was that the vessel could collapse, and the patient would crash shortly after the procedure.

Even with the new technology, prognoses for coronary artery patients like Zalman seemed bleak for much of the latter half of the 20th century: either sustain a major heart surgery or a less invasive one—neither promised to solve future artery clots, the less invasive option had a 50-percent failure rate, and both carried significant fatality odds. Yet researchers did not yield to the grim statistics.

After listening to a lecture on balloon angioplasty by Gruentzig in 1978, a young vascular radiologist named Julio Palmaz had a monumental streak of inspiration. Palmaz, born and educated in Argentina, had recently begun a residency at the University of California at Davis. Considering the problem of restenosis, Palmaz wondered if the balloon could extend inside a sort of tiny scaffold which would remain in the vessel after the balloon deflated and prevent reclosure.

Dr. Stewart Reuter, then co-chair of Palmaz’s department, encouraged him to pursue his idea. By 1983 Palmaz had created prototypes including cardboard and wire models. Reuter, who had since become chair of radiology at University of Texas Health Science Center in San Antonio, was so impressed that he offered Palmaz a position as head of the Interventional Radiology Section at UTHSCSA, with enough time and research to progress his scaffolding theory.

“Once I had this idea, it became clear that was an opportunity that I really had to meet,” says Palmaz, reached by phone at his Napa Valley vineyard where he now spends most of his time while still maintaining a position at UTHSCSA. Palmaz toiled in lab tests, aided by his UTHSCSA colleagues and small grants, but he was rapidly running out of funding. “I had a significant problem as I tried to get it bigger in scope,” he says. He approached companies to underwrite his research but they repeatedly rebuffed him. “I always say that the main reason why people were not interested was that there were too many possibilities at the time that were not proven… the stent had to wait in line until, one by one, all those other possibilities were proven ineffective.”

Meanwhile, Palmaz met Dr. Richard Schatz, a cardiologist at Brooke Army Medical Center. Just as Palmaz’s enthusiasm started to flag, Schatz stepped in.

An early practitioner of angioplasty in San Antonio, Schatz was frustrated with the procedure’s failure rate. “If you were a busy angioplasty guy and you did 10 cases in one day as I was doing,” he says, “every night one or two patients were crashing and you were there all night.” He immediately gravitated toward Palmaz’s idea and contributed to the research.

“I felt like my contribution would be to find some money so that we could keep going,” says Schatz from his office at Scripps Green Hospital in San Diego, where he moved in 1990.

For Palmaz and his project, it was a game changer. “I was able to get small grants but nothing in the magnitude that I needed to push it forward,” says Palmaz. “So, in that respect, Richard Schatz was instrumental. He gave me a lot of emotional and moral support at a time when I was kind of getting discouraged.”

Schatz helped land funding from Texas restaurateur Phil Romano, of Fuddrucker’s and Romano’s Macaroni Grill fame, whom he met by chance on the Dominion Country Club golf course. “Romano put up a significant amount of money, far beyond what I ever dreamed I could get at the time, and we were able to carry things forward,” Palmaz says. “Money makes everything possible.”

By 1985, a group formed by Palmaz, Romano and Schatz registered for a patent on the Palmaz-Schatz balloon-expandable stent, and in 1986 secured Johnson & Johnson as the licensee. The stent, made of stainless steel mesh, functioned largely as Palmaz had initially envisioned, holding the vessel open and allowing tissue to cover it, making it a permanent part of the artery.

“Everything we did worked,” says Schatz. “Every one of our ideas about how to make it work, worked.” Not that every part of development was so easy. Schatz also admits, “Everything was a problem… everything was a barrier because there were no books. So we had to make it up as we went along.”

In 1991, more than 12 years after Palmaz first sketched out a stent, the Food and Drug Administration approved it for use in peripheral arteries. In 1994, the stent was approved for use in the coronaries.

“The first time I met Julio Palmaz and saw the work that he had done, I knew that he was on to something… The results were pretty staggering,” says Schatz. Restenosis rates, long the bête noire of angioplasty, were dramatically reduced by the stent to approximately 25 percent. It also prevented a rapid reclosing of the blockage site, which was the leading cause of angioplasty patients needing emergency surgery.

The noninvasive nature of angioplasty allows many patients to return to their normal life relatively quickly. Zalman entered the hospital Thursday afternoon and left Monday morning with two stents. Today stents are implanted into more than 2 million patients annually, from international VIPs like the late Mother Teresa and former President Bill Clinton to regular folks like Zalman. The inventors and UTHSCSA have also benefited from the stent.

Intellectual Property magazine named the Palmaz-Schatz stent one of 10 patents that changed the world. The National Inventors Hall of Fame inducted Palmaz in 2006. Through licensing agreements, UTHSCSA nets more than $2 million a year from the device.

Yet no one is resting on laurels. “Until we get a zero-clotting rate and a zero-restenosis rate, we’re not going to be happy,” says Schatz. At Scripps, Schatz researches combining stem cell and gene therapy with the stent.

At UTHSCSA, Palmaz and Dr. Eugene Sprague, professor of cardiology and radiology, founded the university’s Bioprosthetic Surface Laboratory, which has already developed two new stent ideas unlike any others on the market. One features a surface of tiny grooves and another relates to creating stents with nanotechnology, similar to that used to create microelectronics. Both stents seek to promote healing around the implant area. As it stands with any stent right now, “The good news is that we open the vessel with these stents and the bad news is that we cause a pretty significant injury,” says Sprague, noting what occurs after a balloon stent has crushed diseased tissue into the artery wall.

“What happens after we injure that, there’s a healing process that occurs and also often there’s scar tissue that forms,” Sprague continues from his UTHSCSA office. The scar tissue can build up around the stent and inhibit blood flow, contributing to restenosis later. Currently, some stents release drugs that prevent scar tissue from ever forming, but Sprague and others claim this means the stent site never fully heals. Palmaz and Sprague are interested in speeding up the natural healing process of the artery lining without using drugs or other agents. Their advances continue to keep UTHSCSA at the forefront of stent development.

Results could always be better, but no one denies that the stent revolutionized cardiac care. Since returning home in July, Zalman tries to maintain a healthy diet and active lifestyle. In late September his cardiologist said Zalman had “no limitations” on physical activity, though he’ll likely remain on medications, including a blood thinner and high blood pressure and cholesterol treatments, for the rest of his life. “I feel pretty good,” Zalman says. “The technology is phenomenal. If this happened 30 years ago, I probably wouldn’t have survived this event.”