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Dotter Interventional Institute

Clinical Work

Acute stroke treatment with selective intra-arterial thrombolysis.

The most brilliant advances in medical technology and research are only as useful as our ability to apply them in the clinical setting. In keeping with this philosophy, the Dotter Institute serves as a beacon of both internationally recognized research and locally delivered advanced clinical care.

Patients throughout Oregon and the northwestern United States are regularly sent to the Institute for management of complex vascular, biliary, and genitourinary diseases. Although physically located on the campus of Oregon Health & Science University, the Institute also provides exclusive full-time service to Doernbecher Children’s Hospital and the Portland Veterans Affairs Medical Center. In addition, the Institute works closely with the Shriner’s Hospital of Portland to provide interventional services on a case-by-case basis. Through these interactions, the Institute makes high-level care available to patients from a broad range of backgrounds and financial circumstances.

Successful thrombolytic opening of the occluded middle cerebral artery in a patient with acute stroke with complete clinical recovery. A) Before, B) after treatment.

The Institute’s clinical facilities include six dedicated angio-interventional suites, one of which has also been certified to function as a satellite operating room under the Institute’s domain. Within the past 18 months, three of the six suites have been extensively remodeled and fitted with the newest, most technologically advanced angiographic equipment available anywhere in the world. A fourth room is expected to undergo similar upgrades within the next year, after which it will be certified as a second satellite operating room. Ancillary equipment includes dedicated vascular access ultrasound, a higher-power ultrasound machine for combined sonographic /fluoroscopic procedures, and an intravascular ultrasound unit. When computed tomography (CT) is required for aspiration and/or drainage procedures, four separate machines are available through the departments of diagnostic radiology at both OHSU and Veterans hospitals.

Embolization of three arteriovenous malformations in the right lung. A) Before, and B) after embolization.

In addition to traditional catheter-directed angiography, the Dotter Institute is responsible for magnetic resonance angiography (MRA) of the aorta, pelvis, and peripheral vasculature. The decision to pursue MRA rather than conventional angiography is made on a case-by-case basis in consultation with the referring clinical staff. Three 1.5 Tesla MR suites are available for these studies, two of which are equipped with moving table technology. This equipment allows the latest advance in non-invasive imaging – digital subtraction gadolinium bolus chase MRA – to be applied immediately to clinical practice.

Among the highly specialized clinical programs at the Institute are: an integrated, multispecialty clinic for treatment of hereditary hemorrhagic telangiectasia; an emergency response team for stroke thrombolysis; and the region’s most active practices in transjugular intrahepatic portosystemic shunt (TIPS) placement, carotid and intracranial artery angioplasty/stenting, and uterine artery embolization for fibroids. In addition, the Institute has pioneered the clinical use of stents in the treatment of benign biliary disease and stent-grafts for recurrent TIPS stenosis. As a result of these activities, the Institute has experienced an increase of more than 100 percent in its annual caseload since its founding in 1990.

Embolization of large uterine fibroid done on outpatient basis. A) pelvic angiogram shows highly vascular fibroid. B) embolization occluded the fibroid vasculature.

Aside from its established programs, the Dotter Institute delineates new protocols for clinical research. Ongoing studies include a modification of the access technique for TIPS, called DIPS, and the development of a new imaging coil and new imaging protocols for MRA. Developing projects include participation in multi-center trials of an endovasacular stent graft, a new MRA contrast agent, and uterine artery embolization versus hysterectomy in the treatment of uterine fibroids.

Even with the newest and most complex techniques being employed, more than 50 percent of patients treated at the Institute are managed on an outpatient basis. The result is decreased health-care costs and increased convenience for these individuals. An Interventional Recovery Unit (IRU) makes outpatient management possible with 13 private beds and a team of skilled nurses who provide routine post-procedure monitoring. Should an individual patient require a longer period of observation, the Dotter staff has had admitting privileges at OHSU Hospital since the late 1960’s.

Successful stenting of cranial (petrosal) portion of the internal carotid artery. A) Before and B) after stenting.

The key to the Institute’s tremendous success in the clinical arena is the strong sense of collegiality and trust among the Dotter staff, the referring clinicians, and allied care specialists. Fostered by a common goal of providing exceptional care, this mutual respect is supported by ongoing dialogue and bilateral participation in patient management. Each member of the healthcare team is thus able to combine his or her expertise with that of other practitioners. For the patient, there can be no better situation.