Wednesday, March 07, 2001
VP's heart procedure not latest available
Area patients benefit from new method
By Tim Bonfield
The Cincinnati Enquirer
More than 150 people in Greater Cincinnati have already received more sophisticated cardiac care than Vice President Dick Cheney.
Mr. Cheney, who has a long history of heart trouble, sought medical care Monday after suffering short bouts of chest pain.
He underwent a balloon angioplasty to open a partly reclogged artery and was released Tuesday from George Washington University Hospital. In November, he had a similar operation, which also involved placing a stent in the artery; but scar tissue partly covered the stent.
However, unlike a growing number of Tristate cardiac patients, Mr. Cheney did not receive radiation treatment to prevent the blockage from happening again.
That shocked Dr. Dean Kereiakes, a Cincinnati cardiologist and medical director of the Lindner Clinical Trials Center.
If Dick Cheney was being treated at the Christ Hospital, we probably would have given him radiation therapy, Dr. Kereiakes said. This is not experimental therapy anymore. We already have some (radiation) treatments approved by the FDA, and others are in development.
Over three years of clinical trials with various devices and more than three months of nonexperimental use, more than 150 cardiac patients at Christ Hospital have been treated with radiation, Dr. Kereiakes said.
Just north of Cincinnati, the new Dayton Heart Hospital also has announced that it has begun using FDA-approved radiation devices.
Without radiation, Mr. Cheney stands a 50 percent to 60 percent chance of suffering another reclogging, or restenosis, episode within three to six months, Dr. Kereiakes said. With radiation, the odds of restenosis would be cut in half, he said.
Dr. Kereiakes' prediction was somewhat more dire than Dr. Jonathan Reiner, Mr. Cheney's heart doctor, predicted on Tuesday. Dr. Reiner said there is a 40 percent chance the vice president would need another angioplasty.
A spokeswoman from George Washington University Hospital refused to comment on Dr. Kereiakes' statements. The White House Press Office also was contacted Tuesday, but spokespeople did not comment.
Dr. Reiner did briefly discuss the radiation issue at a Monday press conference. His comments were posted on the hospital's Web site:
As for ... whether or not radiation therapy can be used now - it's possible. There are some operators that will radiate with the first restenosis, which this is. Then there are others who will wait for it to come back, Dr. Reiner said. I think predominantly we can get a good result with balloon angioplasty, and often this is all it takes to attain a durable result.
Mount Adams resident William Elfers feels Mr. Cheney's pain. The 81-year-old retired firefighter had five-vessel bypass surgery after a heart attack six years ago. About eight months ago, he had three stents installed.
Two weeks ago, Dr. Kereiakes treated Mr. Elfers with radiation after one of the stents began to clog.
Since then, I've felt real good, Mr. Elfers said. Had I not went through with the radiation, they would have had to do open heart surgery again.
In recent years, the use of stents has rapidly moved from an experimental procedure to an everyday part of cardiac care. Like Vice President Cheney, thousands of Tristate residents are living today with stents.
Doctors closely affiliated with Christ Hospital install more than 2,500 stents a year.
Most patients do well with stents. However, 20 percent to 30 percent suffer restenosis, or reclogging, within six months of surgery.
For anybody who gets restenosis, radiation therapy will be the standard of care, Dr. Kereiakes said. It's the only thing so far that has had a dramatic effect in preventing recurring scar tissue formation.
So far, the U.S. FDA has approved two products that deliver radiation to a blocked coronary artery. Cincinnati-area patients have participated in testing these products through the Lindner Center, Dr. Kereiakes said.
In November, the FDA approved the Beta-Cath System made by Novoste Corp. This device uses a beta radiation source to fight scar tissue build-up. At Christ Hospital, doctors are performing five to seven treatments a week using this system, even as testing of other systems continues, Dr. Kereiakes said.
Also in November, the FDA approved the Checkmate system made by Cordis Corp., a unit of Johnson & Johnson. This device uses gamma radiation to fight scar tissue growth. Several years of study in the United States, involving hundreds of patients, reported a 42 percent reduction in restenosis rates.
However, there's a new generation of stents on the horizon that may limit the need for radiation treatments.
Several companies are working on stents coated with medications that may prevent restenosis. Christ Hospital will begin testing some of these devices within weeks, Dr. Kereiakes said.
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