Angioplasty, Discovered at OHSU, Celebrates 40 Years
01/30/04 Portland, Ore.
Plaque honoring Charles T. Dotter, the procedure's inventor, to be unveiled Feb. 5
It's one of the most common medical interventions on the planet. Each year, millions of people undergo the procedure. And it has spawned some of the most important innovations in biotechnology.
It's angioplasty, and it all started in a small radiology suite on the 11th floor of Oregon Health & Science University Hospital.
On Jan. 16, 1964, Dr. Charles T. Dotter, considered the father of interventional radiology, performed the world's first percutaneous transluminal angioplasty, a procedure in which a tapered Teflon catheter was used to open a blocked artery with the help of a live X-ray shown on a television monitor. The procedure allowed an 83-year-old woman to keep her gangrene-ravaged left foot, which was nearly amputated due to a blocked artery.
Today, 40 years later, angioplasty is one of the most common procedures for opening blocked blood vessels. It is performed more than a million times each year in the United States, according to the American Heart Association, and is used in virtually every major artery and tubular structure in the human body.
To celebrate the 40th anniversary of Dotter's groundbreaking procedure, the Dotter Interventional Institute will dedicate a plaque at noon Thursday, Feb. 5, on the 11th floor of OHSU Hospital, just down the hall from Dotter's original angioplasty suite.
Frederick S. Keller, M.D., professor of surgery and interventional radiology in the OHSU School of Medicine, and director of the Dotter Institute, said the event is a chance to showcase angioplasty and its evolution in medicine, highlight the institute's past and current work, and remember Dotter's creative spirit and unflinching drive.
Dotter "was a very innovative, creative thinker and developed many tools for interventional radiology," Keller said. "When he first did his procedure, we had only one small angiography suite. Now we have four state-of-the-art rooms at OHSU."
John G. Hunter, M.D., chairman of surgery in the OHSU School of Medicine, said Dotter knew where surgery was headed, long before the surgeons.
"He understood that video, ultrasound and radiological imaging would transform the art, creating procedures that were every bit as good, or better, than what might be accomplished through a long incision," Hunter said. "It took us 20 years to catch up to his creative mind."
Interventional radiology, known literally as "image-guided, minimally invasive surgery," was born out of diagnostic angiography, the examination of blood vessels that are illuminated on an X-ray when a substance is injected into the blood stream. Dotter first spoke about interventional radiology in June 1963 at the Czechoslovak Radiological Congress in Karlovy Vary, in what is now the Czech Republic.
During an hour-long presentation before 300 people, including many prominent European angiographers, Dotter lauded the potential benefits of the angiographic catheter not just in diagnostic observation, but also in biopsies, catheterizations, endarterectomies and other surgical procedures. He received a standing ovation.
"For those of us in the audience, it was like a bomb had been dropped," Keller and Josef Rösch, M.D., professor of interventional radiology in the School of Medicine, wrote in a piece for the July 2003 edition of the Journal of Vascular Interventional Radiology as part of the 30th anniversary of the Society of Interventional Radiology. John A. Kaufman, M.D., OHSU professor of interventional medicine, also was a co-author.
At that time, all physicians performing angiography had only one thing in mind: "... To deliver an exact diagnosis to our referring clinical colleagues, internists and surgeons, thereby allowing them to select proper treatment. Until then, none of us had even thought that we might be able to treat patients ourselves with use of catheters and guide wires" and avoid the physical and psychological trauma of a big incision, dissection and healing required with traditional surgery, according to the journal article.
While Dotter's percutaneous transluminal angioplasty was widely accepted by the late 1960s by European angiographers, who referred to his technique as "Dottering," there was resistance to the procedure in the United States, particularly among traditional surgeons.
"Surgeons were completely against it. They didn't give him too much credit at the time," said Roesch, director of research at the Dotter Institute.
But Roesch, who performed angiography in his native Czech Republic for 13 years before Dotter recruited him to Portland in 1967, believes the method's incorporation into standard medicine was inevitable.
"It was headed in that direction," he explained. "When I was in Prague, I did high-quality diagnostic work that was internationally recognized. But when I came here, the whole concept changed for me. I could do not only diagnostic work, but I was able to treat patients. I started thinking about and developing new techniques of treatment."
The medical technology industry also was inspired by Dotter's methods. Soon after his discoveries, Dotter began working closely with Bill Cook, who founded the medical device manufacturing company Cook Group, to develop tools that would spur the advancement of angioplasty. In 1989, four years after Dotter's death, Cook donated $2 million to establish the Dotter Interventional Institute as a multidisciplinary center directed toward education, research and patient care in interventional treatment, and his support continues.
The Dotter Institute's interventional radiology research continues to produce techniques and technology that help doctors hone their skills in what's been called "surgery without scalpels." Education for budding interventional radiologists, as a result, also is advancing through institute-sponsored educational meetings and symposia.