As we are preparing for the latest edition of the Emory interventional conference, bringing together those with experience in new techniques to share their knowledge with those with little experience and each other, I am reminded of how powerful this educational process has been in interventional cardiology. The focus of this EPIC symposium is the use of drug-coated balloons (DCB) in coronary interventions. Since the greatest experience with these procedures is outside the United States, those experts and more recent high-volume US operators have committed to this program, not only to teach but to learn for themselves. It reminds me of the early days of angioplasty when I would travel to Zurich to observe Andreas Gruentzig using his technique and have discussions with all who had performed the procedure. Everyone learned from teaching each other. Perhaps interventional cardiology has used this collaborative educational method more than any other medical discipline. When Andreas joined us at Emory and we continued those courses, the same spirit prevailed. Many lessons were technical, such as how to redirect a guide catheter to intubate the LAD or circumflex with the bulky fixed wire balloons or how to select balloon sizes to avoid acute complications and achieve lasting results, but also how to select appropriate candidates for the procedure. Perhaps some lessons learned from those early angioplasty days will be applicable to DCB procedures without stents, but many more lessons will be learned as modern equipment and techniques are applied.

Sometimes the lessons that were learned by those contemplating performing angioplasty were different from their expectations. During the first course at Emory, Andreas selected as the last demonstration case a patient with a proximal LAD lesion that he said was optimal for angioplasty. It was a type A lesion, very tight and short. He told the audience that if you decide to begin performing angioplasty, do not try a very complex lesion that may not be successful, but a simple one like this. I was moderating this procedure and after his statement and the first inflation we could see that the vessel had become occluded. Within a few seconds the patient was in ventricular fibrillation and CPR was begun. I stopped the transmission immediately and explained to the stunned audience that the unexpected can always happen and we must be prepared. Fortunately, the patient survived and some of those contemplating beginning to perform the procedure decided not to. Maybe unknown patients' lives were saved by this experience. However, most lessons learned were not so dramatic but gradually contributed to the accumulation of knowledge from experience among interventional cardiologists. Over the ensuing years, much was learned about new technologies and from randomized trials, but the greatest improvement in expertise has accumulated from experience and much of that has been shared experience. Is some of that sharing imperiled?