In the first or second year of his medical residency training in the US in 1978, Palmaz went to an early meeting of the Society of Cardiovascular Intervention and Radiology in New Orleans. The keynote speaker was a young professor from Germany, Andreas Grunzig, who was coming to the states to report on his early experience with balloon angioplasty. Grunzig was charasmatic and intelligent, and explained balloon angioplasty so clearly--benefits and potential risks--that when he came to the reasons for failure, Palmaz immediately began to think of solutions to the problem. Palmaz describes the problem: early failures showed that balloon angioplasty was inconsistent. Palmaz describes how he began to work on a solution--he first wrote down his idea. He described his idea to his chairman on the way to the airport, and was encouraged to write it up to put his thoughts down on paper.