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An 82-year-old woman was suffering from great pain in her left foot because of blocked circulation in her leg. Her toes had become gangrenous and there was an non-healing ulcer. Amputation was recommended by the physicians at Oregon Health Sciences University, but the woman refused. Luckily, the surgeon in charge of the case knew of Dr. Dotter’s interest in the possibility of using a catheter to open a blocked artery. Like all radiologists, Charles Dotter routinely did imaging studies for the surgeons. He would thread a hollow-tubed catheter inserted through a small needle into the femoral artery to squirt dye into the leg (and other) arteries, and then to take an X-ray (angiogram) showing the circulation and any blockages. Using these pictures, the surgeon would know where to operate. But Dotter had a theory. What if, instead of just using the catheter for dye delivery and imaging, what if he could actually push the catheter itself through the blockage and open up the circulation — from within — without surgery? What if, instead of just imaging the artery, he also could treat it? Given the dire prognosis and the patient’s refusal for amputation, the surgeon decided to let Dr. Dotter see if he could do something. And he did. On January 16, 1964, Charles Dotter imaged the patient and saw that she had a short blockage in the superficial femoral artery (SFA), not far from the needle puncture used for imaging. He proceeded to slide a series of catheters through the blockage, from narrow to wider, one after the other, slowly dilating the area that was blocked. And it worked! The stenosis was opened, on the catheterization lab table, without surgery. As for the patient, the pain stopped in about a week and the ulcer healed completely. Her foot no longer required amputation and follow-up angiograms showed that the artery had stayed open. This seminal and successful event was the beginning of interventional medicine. Dotter began refining and inventing new catheters and wires, working closely with Bill Cook, founder of Cook Medical. Dotter’s ideas, however, were rejected out-of-hand by the vascular surgical community in the United States; he was, in fact, dubbed “Crazy Charlie” and as late as 1970 was called "a buffoon" by a prominent vascular surgeon at a meeting of the Society for Vascular Surgery (SVS). But European doctors, specifically Eberhardt Zeitler of Germany, visited him in Portland and brought his techniques to Europe. There a young angiologist named Andreas Gruentzig met Zeitler and came up with the design for a balloon on the catheter. Within a few years, with the support and help of Dr. Richard Myler of San Francisco, Gruentzig performed the first coronary angioplasty in 1977. Dotter also innovated in the area of communications. In order to publicize his findings, he made a movie in 1965 which was screened around the world. In the 6 minute clip below, you'll see part of that film, which was narrated by Dotter himself. The clip is excerpted from my 1985 documentary, “Explorers of the Heart" which I made as a testimonial to the four giants of cardiology, all of whom passed away in that same year: Charles Dotter, Mason Sones, Melvin Judkins, and Andreas Gruentzig.
Reported by Burt Cohen, January 16, 2021 (updated from previous posts in 2014 and 2019) |
