CRAIG T. KOJIMA / CKOJIMA@STARBULLETIN.COM
Christopher and Audrey Hong at their Foster Village
home on Oct. 31.

Opening paths
to the heart

A procedure by doctors at
Queen's improves treatment
of blocked arteries

---

By Helen Altonn
haltonn@starbulletin.com

Vice President Dick Cheney didn't have it, but Christopher Hong of Foster Village did.

It's called vascular brachytherapy, a treatment used for cardiac patients with repeated blockages of arteries opened by balloon angioplasty or stents.

Hong said he wouldn't have made it to his 76th birthday Oct. 30 if not for Dr. John Cogan and the new procedure at the Queen's Medical Center.

Cogan, an interventional cardiologist, and a team of radiation and cardiovascular specialists treated Hong with vascular brachytherapy Oct. 10.

Hong and his wife, Audrey, frequently traveled on cruises until he was "kind of landlocked" by his health.

"Since April it's been like a ship's engines -- stopped," said the retired chief of the city's waste-water treatment plants.

DENNIS ODA / DODA@STARBULLETIN.COM
Cardiologist John Cogan, in his office, is part of a team
of doctors doing a new procedure to prevent artery
blockages in patients with stents or angioplasties.

Brachytherapy, previously used for cancer patients, was approved by the Food and Drug Administration about two years ago to treat and prevent restinosis. This condition occurs when scar tissue builds up and plugs coronary arteries after angioplasty or a stent, a small stainless-steel mesh tube.

Blockage recurs in about 50 percent of the cases, Cogan said, while only 5 percent have repeat restinosis after brachytherapy.

"It's a dramatic reduction in necessity for repeat procedures, which we humorously call the 'frequent flier club,'" Cogan said.

He said vascular brachytherapy would have been the correct procedure for the vice president when he was recently hospitalized in Washington with restinosis and a repeat angioplasty.

Hong said he had a heart bypass operation in 1984 in Los Angeles and has since had two angioplasties and five stents at Queen's.

Three months ago, Cogan and his partners began performing vascular brachytherapy at Queen's.

Dr. Frederick Pashkow, medical director of the hospital's Heart Institute, said the costs per procedure are slightly higher, but the reduction of follow-up procedures is expected to save more than $500,000 in one year.

Cogan said more than 2,000 coronary interventions are done annually in Hawaii, and 95 percent involve stents. In one out of six cases, scar tissue builds up in the artery and blocks blood flow to the heart, he said.

"That's where brachytherapy fits in," Cogan said, explaining it would benefit about 15 percent of those patients.

Hong said Cogan found his heart was not pumping well enough, and an angiogram showed "real narrowing of the blood vessels." The cardiologist put four stents in his bypass vessel and one in his original heart vessel, he said.

"I was barely getting by at that time," he said.

An angiogram late in September showed the stent in his original vessel was plugged again, Hong said.

In vascular brachytherapy, Cogan said, scar tissue is pushed out of the way with balloons, and a hollow plastic tube is passed through a catheter to the treatment site. Beta radiation "seeds" are sent through the catheter to the lesion, left about three to four minutes, then removed.

The procedure takes about an hour and involves an overnight hospital stay.

"The good news is, stenting and angioplasty are simple and safe, with a rapid return to work, tennis and golf, compared to bypass surgery," Cogan said. "But it's a nuisance to have to go back every so often and have the thing redone. ... Frequent fliers (with restinosis) come back in four months."

Hong said he feels "lucky and glad to be alive and thanking God for everything."

He said he bought a bicycle to gain strength and looks forward to visiting San Francisco, where he and his wife have gone two to three times a year.

"And if I could, I'd like to go on the Norwegian Star when she starts running here," he said.

Instead of a ship, however, they went to a hotel for a few days to observe their birthdays and the "miracle" of his life.

"It's been a tough two years," said Audrey Hong, who turned 75 last Thursday. "I thought it was time for celebration."

The team Queen's Medical Center's cardiovascular radiation brachytherapy team includes Drs. John Cogan and Lee Guertler, interventional cardiologists; Drs. Thanh Huynh, Vincent Brown and John Lederer, radiation oncologists; Scott Dube, radiation physicist; Mel Komatsu, Cardiovascular Invasive Services manager; Brian Oyadomari, radiation technician; and Duane Uyehara and Derek Moore, cardiovascular technicians.