Jim Reekers from Amsterdam, the Netherlands, is professor emeritus of radiology at Amsterdam University and a pioneer in interventional radiology (IR), having been involved in the field since the late 1980s. He is also a strong-minded advocate for image-guided treatment and evidence-based science. He will receive the ESR Gold Medal, the society’s highest distinction, at ECR 2020. ECR Today looked back at the trajectory of this exceptional radiologist and asked him what is coming next in IR.
ECR Today: You were appointed professor of radiology at Amsterdam University in 1999 and established a special interventional section to develop new procedures. Can you name a few?
Jim Reekers: I’m the co-inventor of subintimal angioplasty, the hydrolyser thrombectomy catheter, the optease caval filter and the Reekross catheter. I was also among the first physicians to work on extreme crural revascularisations.
I think subintimal recanalisation is probably my favourite work, as this has now become a standard treatment worldwide for difficult vascular occlusions.
ECRT: What was it like to imagine a field that did not exist?
JR: It was exciting to overcome technical challenges and to push the envelope to create new IR solutions for surgical treatments.
ECRT: You are now retired from clinical practice, but are you still working to advance IR?
JR: I started to realise five years ago that many of the problems we have with vascular interventions in patients with critical ischaemia cannot be overcome by developing new technologies. The blind spot is that we, as IRs, still think like plumbers when we treat vessel disease. We are lacking the basic knowledge about vascular physiology.
I have developed a computer algorithm, together with Philips, to measure true tissue perfusion of the foot after revascularisation. I am convinced that this knowledge will help us to understand our current problems and to make better and more scientific decisions about how to treat patients with peripheral vascular disease.
I am currently leading a huge global research project to validate this new perfusion algorithm, which is called perfusion angiography.
ECRT: You have spoken out for evidence-based medicine and are a famous critic of using new interventional technologies without proper clinical evidence. You have notably denounced the influence of the pharmacological industry in organising so-called ‘evidence’. Could you please explain?
JR: The main problem with almost all pharma trials in IR is that they use easy-to-obtain, pseudo or proxy endpoints to prove the efficacy of their products. However, a patient is only interested in clinical endpoints. For example, a patient with intermittent claudication wants to walk a longer distance after intervention, however the pharma industry only reports if a vessel is still open after 12 months and not if a patient can walk a longer distance. The industry suggests that open vessel is the same as better walking distance, but that is only true in 50% of the treated patients.
I recently had a letter to the editor published in The Lancet, about a published trial, to point out that the actual increase in walking distance after a drug eluting stent is only 40 meters, and therefore irrelevant for patients who already walked 300 meters when they entered this trial1.
I also had an editorial published on the flawed CCSVI treatment for MS2. But I wrote many more of these critical letters and editorials, for example recently in CVIR Endovascular3.
ECRT: What about the FDA and CE marks in terms of validating new IR products: are these approvals strong enough?
JR: No, as an industry you only have to prove safety but not efficacy to obtain CE marking. So, as long as a product is not unsafe you can sell it, even when it does not work. But even when safety is disputed after CE and FDA approval, the industry will do everything to sweep this evidence under the carpet, such as in the case of paclitaxel-related deaths, for example.
ECRT: You initiated the European Curriculum for Interventional Radiology and the European Board of Interventional Radiology (EBIR) examination, which is now the standard for the field. What do you think of initiatives like ‘The Cube’, which is now taking place for the third time at the ECR, to promote the field to young residents and students at the congress?
JR: I think this is a great idea to make young radiologists enthusiastic about IR. But I have been there a couple of times and I am missing the critical voice to counterpart the industry messages. Think for yourself, do not believe all you hear. Be scientific and critical.
I am really missing education for young radiologists to think scientifically and to make decisions based on true facts and not pseudo-science.
1 Key points to consider in the IMPERIAL trial. Lancet. 2019 Jun 22;393(10190):2489-2490. doi: 10.1016/S0140-6736(19)30693-2
2 A swan song for CCSVI. Cardiovasc Intervent Radiol. 2014 Apr;37(2):287-8. doi: 10.1007/s00270-013-0833-6. Epub 2014 Jan 9
3 For the times they are a-changin’? CVIR Endovasc. 2019;2(1):5. doi: 10.1186/s42155-018-0045-x. Epub 2019 Jan 8