Spinning Needle Touted as Treatment for Severe Angina
Dec. 15, 1999 (Washington) -- In what is being described as a first for the
United States, a 53-year old man with severe angina has been treated for the
crippling condition Wednesday with a tiny, spinning needle that poked 15
precisely arrayed holes in the left ventricle of his heart. Angina is chest
pain caused by inadequate blood flow in the arteries that supply blood to the
"I feel much better. I'm breathing better," said Norman Ridgeway, as
the medical team was still hovering about him in the catheterization lab. Over
the last 15 years, Ridgeway has suffered through bypass surgery and 13
angioplasties. Still, his condition has continued to decline to the point that
he can barely walk. In no way is Ridgeway saying that he has been cured, but he
does feel much improved.
The 30-minute procedure, performed under mild sedation by Fayaz Shawl, MD,
director of interventional cardiology at Washington Adventist Hospital in
Takoma Park, Md., was the first in a planned series involving 15 American
patients to determine if the new approach can really work.
Ultimately, Shawl hopes it may benefit the estimated 1 million Americans who
suffer from severe angina.
The technique, pioneered by Shawl, is called mechanical percutaneous
myocardial revascularization (MPMR) and essentially involves running a tube
with a miniature drilling device into the heart. It spins at up to 2,000
revolutions per minute.
In the last 10 years physicians have been treating some of their sickest
angina patients by burning holes in their hearts with lasers -- an approach
generally known as myocardial revascularization. While no one knows exactly why
this works, it's thought that blood flow may be enhanced by the creation of
these new channels.
In spite of its promise, the laser therapy has some drawbacks, says Shawl.
If it's done by traditional surgery, the death rate is almost 10%. Also, the
laser system and equipment cost $250,000, compared to $10,000 to $20,000 for
the drill setup.
Before the procedure, Shawl reviews an image of the patient's heart to plot
his line of attack. Once the catheter is inserted, he puts a transparent grid
over a video monitor and marks it each time he drills a new hole in the heart
wall. Each hole is 5 mm deep and 1 mm wide.
Shawl says Ridgeway's internal heart pressure has been reduced, and the
pumping function of his heart has also improved.
Shawl has done nine of the procedures on patients in India since last
August, and he says they are all doing well. One of the big advantages of the
catheter, says Shawl, is that it allows the physician to withdraw tissue that
can be used for a biopsy. That, he says, may help show what actually causes the
improved functioning of the heart.
Alan Wasserman, MD, tells WebMD that even though these procedures do give
patients short-term relief, more study is needed. "Anything that relieves
pain, especially something like this that is relatively safe and relatively
easy to perform, is a good start," says Wasserman, chairman of medicine at
George Washington University Hospital in Washington, D.C.
The device is manufactured by AngioTrax Inc. of Sunnyvale, Calif., a company
in which Shawl holds stock.