Charles Dotter

Charles Theodore Dotter (1920-1985) portrait

Charles Theodore Dotter (1920-1985) was an American radiologist

Long before “interventional radiology” became a discipline, Dotter treated angiography as a platform for action. Dotter reshaped what a catheter could do, moving from cardiopulmonary diagnosis and catheter-based physiology to ambitious programs in coronary imaging. His early work on balloon occlusion aortography reflected a technical boldness and a conviction that radiology had a responsibility not only to visualise disease, but to make new forms of treatment possible.

The turning point came in 1963–1964, when Dotter articulated and then demonstrated the “intraluminal operation.” In 1963 he publicly argued that the angiographic catheter should be more than a diagnostic tool; within months he and Melvin Judkins performed the first intentional percutaneous transluminal angioplasty, proving that obstructed arteries could be treated from within the lumen and foreshadowing modern endovascular therapy.

A key part of Dotter’s impact was concept-to-toolchain engineering. He imagined new catheter functions, then built the instruments to make them real. Contemporary accounts emphasise his rapid prototyping (often with improvised materials) and the importance of manufacturing partnerships that allowed catheter systems to be scaled and standardised for clinical use. His work quickly expanded beyond dilation into the wider endovascular toolkit with catheter-directed thrombolysis (streptokinase), embolisation methods, foreign-body retrieval, and early intraluminal scaffolding concepts.

Biographical Timeline
  • Born June 14, 1920 in Boston, Massachusetts; raised in Freeport, Long Island.
  • 1941 – BA, Duke University.
  • 1944 – MD, Cornell
  • 1944–1945 – Internship, US Naval Hospital, New York State (St Albans).
  • 1940s – Radiology residency, New York Hospital; later staff/instructor then professor at Cornell
  • 1952 – Appointed Professor and Chair of Radiology, University of Oregon Medical School/Medical Center (Portland); remained chair for 32 years.
  • 1963 (June) – Publicly argued the catheter could be a therapeutic “surgical instrument” at the Czechoslovak Radiological Congress.
  • 1964 (Jan 16) – Performed the first intentional percutaneous transluminal angioplasty with Melvin Judkins; first patient Laura Shaw (82) with superficial femoral stenosis and threatened limb loss.
  • 1967–1969 – Developed axillary lymphadenopathy; later diagnosed with Hodgkin disease after night sweats and biopsy; continued working through radiotherapy.
  • 1970 – Climbed the Matterhorn guideless after responding to therapy
  • 1979–1980 – Major cardiac surgery and emergency surgery (coronary bypass; perforated duodenal ulcer); returned to work afterwards.
  • Died February 15, 1985.
Medical Eponyms
Dotter technique (1964)

Definition – Percutaneous transluminal angioplasty (PTA) using progressively larger coaxial catheters to traverse and dilate an atherosclerotic stenosis/occlusion (the original “catheter dilatation” method, pre-balloon era).

Dotter dilatation set (c. 1963–1964)

A manufactured kit of telescoping (coaxial) dilators/catheters designed for transluminal arterial dilatation. Developed after Dotter sketched plans for two telescopic catheters, which were then produced as the “Dotter dilatation set,” enabling the first PTA.

Key Medical Contributions
1949–1951: Catheter-based cardiopulmonary diagnosis and experimental physiology

Dotter’s earliest influential work was in cardiothoracic diagnosis and catheter-enabled physiology. In 1949 he co-reported congenital pulmonary artery aneurysm, and by 1951 he was using a purpose-designed cardiac catheter to model acute cor pulmonale experimentally—early evidence of his lifelong pattern: invent the tool, then use it to answer a clinical problem.

1958–1963: Coronary angiography program: balloon occlusion aortography

Dotter pursued a technically ambitious program to visualise the coronary circulation using balloon occlusion aortography, arguing that improved coronary imaging was a pressing responsibility. His 1958 Radiology paper described a double-lumen balloon catheter briefly inflated in the aorta during contrast injection; the images were striking, but the approach was overtaken once selective coronary intubation became practical.

1962: Flow-guided catheterisation

Dotter also advanced catheter navigation by describing flow-guided cardiac catheterisation. An important bridge between diagnostic angiography and later therapeutic catheter manoeuvres.

1963-1964: The intraluminal operation and first PTA

1963 (June) Dotter’s crucial conceptual leap was articulated publicly when he argued that the angiographic catheter should be used not only for diagnosis but as an active therapeutic tool. He framed the catheter as an instrument capable of intervention “used with imagination,” anticipating the entire discipline of interventional radiology and the later language of “endoluminal surgery.”

The angiographic catheter can be more than a tool for passive means of diagnostic observation; used with imagination, it can become an important surgical instrument.

Dotter 1963

Dotter’s defining clinical leap was treating occlusive disease from within the lumen. In 1963, he inadvertently demonstrated the principle when a catheter passed retrogradely through an occluded iliac artery, a case he reported at the same June 1963 congress.

On 16 January 1964, Dotter and trainee Melvin Judkins performed the first intentional percutaneous transluminal angioplasty, using a wire guide and coaxial catheters to dilate a focal femoral lesion in Laura Shaw (aged 82), who had refused amputation; the limb reperfused immediately and the ulcer healed. This clinical “intraluminal operation” later gained wide surgical acceptance under the label “endoluminal surgery.”

Dotter 1964 Transluminal dilatation
Case 1. Transluminal dilatation and segmental narrowing of the left superficial femoral artery. A. Control arteriogram showing threadlike lumen in region of adductor hiatus. B. Immediately after dilatation with catheter of 3.2 mm. OD. C. Three weeks after transluminal dilatation. Lumen remains open. Clinical and plethysmographic studies indicate continuing patency over 6 months later. Dotter 1964
1971–1975: The wider interventional toolkit: retrieval, embolization, thrombolysis

Dotter’s legacy also includes several “first-wave” catheter therapies that became core interventional radiology practice:

  • Foreign-body retrieval (1971): transluminal extraction of catheter/guide fragments (29 collected cases) and GI foreign-body retrieval were reported the same year.
  • Embolization (1971–1975): early work included vasoconstrictor infusion and embolization methods for GI bleeding, and later “instant” selective occlusion with isobutyl-2-cyanoacrylate (1975).
  • Catheter-directed thrombolysis: Working closely with Josef Rösch, Dotter helped establish catheter-based pharmacologic therapy for vascular occlusion. His Radiology papers on streptokinase moved from broader thromboembolic treatment (1972) to the key concept of selective, low-dose clot lysis (1974), anticipating modern catheter-directed thrombolysis strategies that aim to maximise local efficacy while reducing systemic risk.
1983: Endovascular scaffolding: from coil grafts to expandable stents

Dotter also explored intraluminal “tube graft” concepts, starting with research into long-term patency of coil-spring endarterial tube grafts in animal arteries (1969). In the final phase of his career Dotter again pushed the device frontier, reporting a transluminally expandable nitinol coil stent graft (1983)

Major Publications
References

Biography

Eponymous terms

Eponym

the person behind the name

more eponyms…

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | On Call: Principles and Protocol 4e| Eponyms | Books |

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