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Transradial Access from
the Wrist is Safer, Easier For Many Patients Undergoing
Angioplasty or Stenting of Blocked Heart Arteries
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January
19, 2009 -- A new approach to unblocking heart arteries
minimally invasively using angioplasty or stents will mean
less bleeding, less down time, lower costs and less risk
overall,
particularly
for
obese
patients, according to data being presented at the 21st annual
International Symposium on Endovascular Therapy (ISET).
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Every year, about one million
Americans opt for angioplasty over bypass surgery to open their
blocked arteries. New
data suggests that beginning the angioplasty procedure by entering
through the wrist – rather than through the groin – will make it
safer and easier on patients.
To access the arteries, an interventional physician makes a small incision in the groin at the top of the leg and advances a thin tube (catheter) through the femoral artery to the site of the blockage. A tiny balloon is then inflated to open up the artery, and often a small cage-like tube called a stent is left behind to keep it open. But there is a risk of bleeding and nerve damage at
the femoral artery access site. To reduce the risk, patients must lie down for two to six hours after treatment. Also, accessing the femoral artery in the groin is particularly challenging and risky in obese people.
Accessing the blocked blood vessels through
the wrist (radial) artery, rather than the femoral artery significantly
reduces the risk of bleeding and nerve damage, suggests data on more
than 5,000 procedures performed at Baptist Cardiac & Vascular Institute,
Miami. The radial approach also is easier on patients because they
can sit up after the procedure and walk away almost immediately.
Currently, in the United States, only about
two percent of all minimally invasive heart treatments are performed
through
the
wrist.
The percentageof transradial procedures is higher in other countries, as much
as 50% in some.
“I believe 75 percent of patients would be candidates
for the radial approach if it were an option,” said Ramon Quesada,
M.D., medical director of interventional cardiology at Baptist Cardiac & Vascular
Institute, and ISET course director. “The
radial approach is a bit more technically challenging for physicians,
but once they master it, I think most would prefer it. One of the main
barriers is a lack of training opportunities.”
When the femoral access approach is used, there
is a 2.8 percent risk of bleeding or nerve damage, according to studies.
Most patients spend at least one night in the hospital after the procedure.
Although rare, the bleeding can lead to kidney failure, blood infection
and death. At Baptist Cardiac & Vascular Institute, the complication
rates for the radial approach are extremely low; only 0.3 percent had
bleeding complications. None suffered nerve damage. An overnight stay
may be advisable, depending on the complexity of the intervention performed,
not because of the access approach.
The radial approach isn’t appropriate for all
patients, including those who have very small or twisted arteries or
are extremely thin, said Dr. Quesada.
“Using the radial approach results in lower cost, less time before the patient can get up and walk around and fewer complications,” said Dr. Quesada. “Patients
who are ideal candidates for the radial approach are those who are
obese or have severe peripheral arterial disease (PAD).”
Considered to be the premier meeting on endovascular
therapy, the International Symposium on Endovascular Therapy (ISET)
is attended by more than 1,200 physicians, scientists, allied professionals
and industry professionals from around the world. The meeting pioneered
the use of live cases to promote the multidisciplinary treatment of
cardiac and vascular disease by endovascular means. ISET is presented
by the Baptist Cardiac & Vascular Institute, Miami. ISET 2009 is taking
place Jan. 18-22 near Miami Beach, Fla. For more information, visit www.ISET.org.
About The Radial Access Center on Angioplasty.Org
To assist in educating the professional and patient population
in the U.S. about the this technique, Angioplasty.Org has created
the "Radial
Access Center for Transradial Approach", a special section devoted
to information and news about the transradial technique, for both patients
and physicians. The Radial Center features interviews with leading practitioners
of the radial technique, such as Drs. Jeffrey Popma, R. Lee Jobe, John Coppola,
Shigeru Saito, Kirk Garratt, Tak Kwan and Howard Cohen.
For patients there is also
a "Hospital
Locator" that lists U.S. centers practicing radial angiography.
As Dr. Howard Cohen of Lenox Hill Hospital in New York says of
the wrist technique, "Patients really prefer it. 95% of
people who've had it both ways would say 'I'm coming back to
you, Dr. Cohen because I like this transradial a lot better than
the other way!'
Source: International Symposium on Endovascular
Therapy with additional reporting by Burt Cohen
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