Interview With Timothy C. Ball, M.D., Ph.D.
Share with us your background, such as where were you prior to Carilion, what role, etc.
I earned my M.D. and Ph.D. degrees at the Medical University of South Carolina where I was involved in the study of hematopoiesis, in particular the differentiation and commitment of pluripotent hemopoietic progenitor cells to myeloid and lymphoid lineages. I then did my internal medicine residency at Wake Forest University Baptist Medical Center. On completion of my residency I served in the United States Air Force as a flight surgeon. Following my tour, I returned to Wake Forest where I trained as a fellow in anesthesia critical care prior to pursuing training in cardiology in New Hampshire at Dartmouth-Hitchcock Medical Center. There I trained as a fellow in cardiovascular disease, interventional cardiology, structural heart disease and endovascular intervention. I arrived here in July 2010.
What is your research past? Focus area/interest?
My interest in research began at Clemson University while pursuing my bachelor’s degree in biochemistry. I was subsequently accepted into the Medical Scientist Training Program at the Medical University of South Carolina, where my mentor instilled in me the belief that a “doctor of philosophy is a doctor of thought.” During my cardiology fellowship training, my current research interest in the post-mortem assessment and evaluation of the stented coronary arterial segment developed to address such questions as: Why do stents fracture? Does stent design affect fracture? What is the clinical significance of stent fracture?
We developed a post-mortem autopsy evaluation protocol in which the division of cardiology worked along side the department of pathology in the study of patients referred for autopsy who had history of coronary stenting. The protocol incorporated gross cardiac examination and explanation of the stented arterial segment followed by microscopic computed tomographic evaluation and sectioning of the stented arterial segments with histologic correlation. The resultant data obtained has provided greater insight into “un-natural” history of the stented coronary arterial segment.
We are in the final steps of activating a similar autopsy protocol here at Carilion in collaboration with Virginia Tech.
What is your current role here at Carilion?
I am an Interventional Cardiologist with interest in complex coronary intervention and structural heart disease intervention. I am the medical co-director of the cardiac catheterization laboratory at Carilion Roanoke Memorial Hospital and I serve as the associate program director for the cardiology fellowship here at Carilion.
Tell us about your current and pending projects here at Carilion?
I am a co-investigator in a drug evaluation trial: “A large animal evaluation of infarct limitation with a novel highly saturated nitrate donor.” This evaluation was supported by a Carilion Clinic RAP grant and is being performed in conjunction with Virginia Tech Veterinary School.
In addition, we will soon be activating the Carilion Clinic cardiac autopsy protocol for the evaluation of the stented coronary arterial segment. In the meantime, I continue to be active in the correlation of microscopic computed tomographic images with corresponding histology gaining a greater understanding of stent-vessel, stent-lesion and stent-stent interactions.
Finally, the institution is currently engaged in negotiations to bring two device trials to Carilion. In one, I will be the primary investigator. The other is a multidisciplinary clinical trial with collaboration between neurology and cardiology in which I will serve as a co-principal investigator with Dr. Mallenbaum, the principal investigator.
What made you want to join Carilion Clinic?
When I learned about the academic mission of Carilion and the emphasis on multidisciplinary collaboration with a patient centered focus, I was eager to join the institution. I wanted to seize a rare opportunity to be a part of building academic cardiology and interventional cardiology fellowship training programs. The administration has emphasized a desire to develop far reaching multidisciplinary collaborations between the specialties of cardiology, cardiothoracic surgery radiology, vascular surgery and interventional radiology among others, to optimize and personalize the care and treatment of patients. Furthermore, when I learned that Virginia Tech is home to some of the world’s leaders in the development of computed tomography (CT) and microscopic computed tomography technologies with opportunities for collaboration, the deal was sealed.
Tell us about one project in particular.
The combined microscopic computed tomographic and histologic analysis of intracardiac coronary stents.
What is it – what are the goals?
The coronary stent is a widely used device in the treatment of atherosclerotic disease of the coronary arteries. Despite their widespread use, very little is known about how stents withstand the forces they are subjected to within the artery and if these forces result in stent failure.
Our objective is to develop a repository of data obtained from the analysis of post mortem stented arterial segments. We then plan to build a registry with adequate size and power to gain a greater understanding of stent-vessel, stent-lesion and stent-stent interactions. As the size of the registry increases, our ability to address and answer questions about the natural history of the deployed stent and the stented arterial segment will increase. The development of this database and image registry, including microCT and histology images, will provide insight into the strengths and weaknesses of coronary stents including composition, cell design and strut thickness. This development will also possibly allow us to participate in the design of newer generation stents to reduce late complications.
What are the hoped for benefits of this research?
This type of research will provide many benefits. First, the research will lead to improvements in stent design and possibly the development of vessel specific stents to reduce stent fracture and/or compression, and the complications of restenosis and stent thrombosis. Second, it will allow interventional cardiologists to gain a greater understanding of the 3-dimensional (3-D) relationships within the coronary arteries and allow for better stent deployment within atherosclerotic lesions, possibly minimizing the complications of restenosis and stent thrombosis.
What is the benefit for the community?
There are very few sites capable of obtaining stented coronary arterial segments and then performing microscopic computed tomographic imaging with histologic correlation. The pursuit of this research stands to make Carilion a leader in this area of research and will hopefully lead to greater collaboration with industry in the development of coronary stents and more.
What is your vision for research here – in your department and here at Carilion as a whole?
The cornerstone of every academic medical center must be the advancement of knowledge. My vision is to promote and support scholarly activity and to participate in the advancement of medical knowledge.
How do you see clinical trials impacting public health? How can this assist Roanoke?
Clinical trials allow patients the potential for local access to cutting edge medical therapies years before FDA approval. Only leading academic institutions with proven research track records have access to these trials. By participating in clinical trials, we bring novel and new therapies and devices to the patients of our region, and we put ourselves in a position to have access to the newest trials in the future. With this kind of growth, we will have not only the ability to expand the treatment opportunities available to patients, but also to attract new specialties and subspecialties to the region to participate in an academically rich environment.