Gary S. Roubin, MD, PhD, has always been interested in the elements of medicine that affect the greatest number of patients. As a college student in public health the 1970s, he became aware of the epidemic of heart attacks and cardiovascular disease, a condition that the medical community had few tools to treat. As a result, the Australian native decided to focus on cardiology in medical school at the University of Queensland and at Sydney University.
Roubin’s desire to make a contribution to medicine that would help many people has led him to become an internationally renowned interventional cardiologist. He is recognized for his groundbreaking work in the development of the first Federal Drug Administration-approved coronary stent, as well as in pioneering the techniques of carotid stenting and embolic protection devices.
Currently the medical director at Cardiovascular Associates in Birmingham, Roubin has had an interesting journey that brought him to the United States, including two stops in Birmingham. “I had just finished my PhD and cardiology training when I heard that Andreas Gruentzig, a wonderful and revolutionary physician, had just moved to Emory University in Atlanta,” Roubin says. “He invited me to come as a senior fellow and work with him in the development of balloon angioplasty, which was still a new and unproven technique at that time.”
In the early days of treating cardiac problems, Roubin says they could treat the blockages, but 10 percent of patients developed complications that required bypass surgery, some resulting in death. “I turned my attention to how we could solve that problem, and that’s how I got involved in developing the first coronary stent,” he says. He placed that first stent in a patient in the United States in October 1987. “It took many years, but we were successful and it certainly changed the course of cardiology. There’s no question about that.”
Roubin spent six years at UAB in the early 1980s as Professor of Medicine and Radiology and Director of the Cardiac Catheterization Laboratories and Interventional Cardiology Section of UAB Hospital before accepting a position at Lenox Hill Hospital in New York City. During his 18-year tenure there, Roubin became interested in the possibilities for stenting in the carotid arteries. “At that time, the only way to treat the condition was to perform a major operation on the neck to remove the blockage surgically,” he says. “We had already developed the procedure to treat heart blockages, so we thought we could do the same thing for the carotid. It was while I was at UAB 20 years ago that we developed that procedure, and over the last two decades it has become a successful alternative to surgery.”
Over the past 30 years, Roubin’s interests have included the development of device technology, innovative techniques for the treatment of coronary and peripheral atherosclerosis, research in the application of coronary angioplasty, stenting in patients with multi-vessel coronary disease, and peripheral vascular and carotid disease. He is currently involved with studies that look at the full spectrum of new medications to prevent blood clots during procedures and special techniques to make procedures less invasive and less painful for patients.
Currently, Roubin is focused on phase two of a National Institutes of Health (NIH) study on Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) that compared stenting and surgery for carotid artery disease. Roubin leads the stenting arm of the CREST2 study which compares revascularization and medical therapy for asymptomatic carotid stenosis. The majority of procedures and testing will be done at Brookwood Medical Center.
“Stroke is a leading cause of death and disability in this country and many can be prevented by using the best technique for treatment,” Roubin says. “Right now we think stenting and surgery are the best techniques depending on the appropriateness for the individual patient, but now we have to ask the question ‘are some patients better off with medicines?’ It’s a very important question.”
While innovative surgical techniques have been developed over the past 20 years, medicines for treating atherosclerosis, cholesterol, and high blood pressure also have improved dramatically. As part of an executive group, Roubin and his team approached the NIH with the proposal for the study. “I am delighted that I have joined CVA so I can bring this cutting edge technology and the best treatments to patients here in Birmingham. By joining this incredible group of cardiologists at CVA, we now are set to provide leadership to the rest of the country and the world with the management of the carotid stenosis problem.”
The CREST2 trial will start in October, and physicians at CVA will be able to offer leading-edge treatments for this condition. “We are one of a select group of centers and cardiovascular groups in the country that will run this trial. The patients who participate are going to get five-star medical treatment and will be on exercise programs, special dietary programs and we will monitor their medications,” Roubin says. “The NIH wants only the best operators in the country for this trial, so I’m proud to say that we’ll be leading the charge here at CVA along with Brookwood Medical Center, our medical partner. It will be a game changer for sure, one way or another.”
In his spare time, Roubin enjoys playing polo with his teenage sons and with his long-time friend and celebrity chef Frank Stitt. But his thoughts are never far away from his life’s work. “My time is dedicated to the mission of providing leadership to the organizations that have I have worked with over the past decades, to help them provide excellence in care that is focused on the patient experience because every patient is different,” he says.
For the CREST2 trial, Roubin says was given the opportunity to join medical groups from around the country. “But when I saw what the physicians at CVA have done, it blew me away. They have a state-of-the-art facility and they truly value the patient experience,” he says. “I was in New York City for 18 years and held leadership positions there. Nothing in New York even comes close to what CVA has done here in Birmingham. Coming back to Birmingham, which has always had exceptional medicine, is a wonderful way for me to end what has been an exciting and productive career. I am delighted to be back.”