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April 10, 2010 -- 5:00pm EDT Angiogram Not Angioplasty For Holbrooke In fact, the procedure was an angiogram. Two letters and 10-20 minutes shorter -- but a world of difference. Having reports of chest pains, Holbrooke's doctor ordered a diagnostic test, also known as a cardiac catheterization: a catheter is threaded through the femoral (groin) artery or the radial (wrist) artery to the coronary arteries surrounding the heart. A special dye is injected and, under X-ray fluoroscopy, any blockages can be seen. In Holbrooke's case, no significant narrowings were found and he has, in fact, been cleared for his trip. Had a major blockage been found, an angioplasty might have been done: guide wires rapidly would have been exchanged and a balloon with a stent on it would have been threaded to the blockage, inflated for a short time, deflated and withdrawn. The stent would remain as a scaffold, holding the artery open. Only 20 extra minutes, maybe 10. This is why many angiograms that show blockages are converted into therapeutic procedures, angioplasties, right on the table -- because it's easy and fast to add it on. ("And while we're at it, we'll change the oil...", a cardiologist friend of mine used to quip.) Of course, this instant conversion, also called "ad hoc angioplasty", has come under some questioning since recent studies, notably FAME, have shown that just because you can see the blockage doesn't mean you need to open the blockage up. But that's another story. This story ended well for Ambassador Holbrooke. And by the way BusinessWeek -- clogged heart valves? |
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A
minor print error, but not for Richard Holbrooke,
the U.S. special envoy for Afghanistan
and Pakistan. On Wednesday