Cheney’s Doctors Didn’t Use Latest Heart Treatment

In the aftermath of Vice President Dick Cheney’s most recent hospitalization for heart troubles, some cardiology experts are questioning why he was not treated with a new radiation technology that they say could reduce his chances of a recurrence by more than half.

The technology, approved by the Food and Drug Administration in November, is not yet available in many hospitals--including George Washington University Medical Center, where Cheney was treated March 5. But he could have been sent to neighboring Washington Hospital Center, which has performed more of these procedures than any facility in the world.

Dr. Ron Wacksman, director of experimental angioplasty at Washington Hospital Center, said that “almost all” of its patients with Cheney’s condition are treated with radiation. “We believe in it,” he said. “We know it works.”

However, he added, because it is such a new technology, most patients “are treated conventionally,” as Cheney was, rather than with radiation.

“It is a slow process of launching this into hospitals,” Wacksman said. “But a year from now, things will be different.”

The technique involves implanting tiny radioactive “seeds” for a period of only minutes, then removing them; the radiation emitted from the seeds “paralyzes” tissue cells, preventing them from growing and lessening the likelihood that the device holding the artery open will reclog with another round of scar tissue.

Cheney, 60, suffered his fourth heart attack in November, and doctors implanted a stent--a tiny scaffolding-like device--inside a blocked artery to hold it open.

Last week, doctors discovered that scar tissue had grown within the stent, causing a partial blockage--a condition known as re-stenosis--and performed a standard balloon angioplasty to reopen the area. There is a 40% chance the condition could recur, his doctors said.

Marty Harris, a spokeswoman for George Washington University Medical Center, said that physicians there have been trained in the new radiation procedure and that the equipment has been ordered and “should be here this week.” Moreover, she added, “if the vice president needs it, he’ll get it.”

The medical experts interviewed--who were not directly involved in Cheney’s care--agreed that such treatment decisions are often a judgment call on the part of individual physicians, based on a patient’s medical profile. Most of the experts acknowledged they were lacking sufficient information to be definitive about Cheney’s case.

Nevertheless, some said they believe he could have benefited from the radiation treatment, decreasing his chances of a future trip to the hospital to have the problem fixed yet again.

“They could have put this to rest,” said Dr. Ray Matthews, a cardiologist at Good Samaritan Hospital in Los Angeles. “I think the country was done a disservice by not using all the technology at hand. This is the most exciting new treatment in the past 10 years.”

Dr. Jonathan Reiner, the cardiologist who treated Cheney, was asked during a news briefing why the radiation procedure was not used.

“There are some operators that will radiate with the first re-stenosis, which this is,” he replied. “Then there are others who will wait for it to come back. I think predominantly we can get a good result with balloon angioplasty, and often this is all it takes to attain a durable result.”

He did not mention that the hospital did not have the equipment to do the procedure.

Dr. Jeffrey Popma, director of interventional cardiology at Brigham and Women’s Hospital in Boston, was the lead investigator who studied the procedure in trials of 1,500 patients before it was approved. He said he would have performed the procedure had Cheney shown up in his hospital.

But, he added: “We have it available. We have the resources. We do one or two a day. We’ve worked it into our routine practice. We are geared up to give it, but I can’t criticize anyone who failed to give it.”

Because it is so new, the procedure is not yet covered by most insurance, including Medicare. Such lag time is common with new medical technologies. The procedure costs about $3,500.