Today, Dr. Oz featured cardiac catheterization, angioplasty, and stents from the wrist on his afternoon TV show. Billed as part of his series, “Dr. Oz’s Ultimate Insider’s Guide: The Newest Medical Breakthroughs,” Mehmet Oz interviewed Dr. Jennifer Tremmel, Director of Transradial Interventions at Stanford Medical Center, Clinical Director of Women’s Heart Health at Stanford Clinic and friend of Angioplasty.Org (you can read my interview with Dr. Tremmel in our Transradial Center).
In 10 short minutes, Dr. Oz exposed his viewers (and there are 3 million of them!!) to what he called, “…a radical new procedure that can help you find out if you are at risk for heart disease and treat it at the same time.”
He was talking, of course, about the transradial approach to cardiac catheterization and PCI (percutaneous coronary intervention). And he gets his viewers’ interest by introducing the segment as taking them “behind closed doors” to institutions that are revolutionizing medicine, in this case, his own field of heart disease (Dr. Oz is a cardiac surgeon) — part of his “Ultimate Insider’s Guide.”
Of course, to quibble just a tad, transradial angioplasty is neither new, nor radical, nor “behind closed doors.” At Angioplasty.Org we have hosted a Transradial Center for over five years and, as I wrote earlier this summer, this is actually the 20th anniversary of transradial angioplasty (first performed in 1992 by Dutch cardiologist, Dr. Ferdinand Kiemeneij). The technique, also called TransRadial Intervention or TRI, consists of threading a catheter through to the coronary arteries via the radial artery in the wrist instead of the femoral artery in the groin. Outside of the United States, TRI is used in the majority of procedures. It’s really only in the U.S. where this has been an “unknown” technique. But that is changing: wrist angioplasty is gaining in popularity — in fact it’s doubled in use in just the past few years. And it’s not exactly a total secret. Check out our “Transradial Hospital Locator” for a center near you that practices the wrist approach (there are over 200 listings).
So why is the wrist approach preferable in many cases? Because it is safer, has less bleeding and other access site complications, is more comfortable for the patient, and allows the patient to stand up, walk around, and go home very shortly after the procedure. Why is it not practiced more in the U.S.? Because cardiologists haven’t been trained in the technique during their fellowships, there has been little impetus to alter practice from the comfortable femoral technique. But that’s changing: pioneering physicians like John Coppola and Tift Mann went abroad to learn the transradial technique in Japan, India and Europe, and then brought it back home and taught it to…well, cardiologists like Dr. Tremmel, who now do 80-90% of their cases from the wrist.
Dr. Oz performed a great service for heart patients today by publicizing the transradial approach. Because when I ask cardiologists, “What is the primary driver that will increase the use of the transradial approach?” they answer “Patient preference!”
So now Dr. Oz’s audience of 3 million has gotten an exclusive behind-the-scenes look at this “new” procedure that many cardiologists outside of the U.S. have used for years…but the truth is that this TV show will definitely drive greater adoption of this technique here.
And interestingly, when referring to the femoral (groin) approach to catheter-based procedures, Dr. Oz called it “the old-fashioned way!” You heard it here. Don’t be old-fashioned. Get with the times. Learn the transradial technique!
Thank you Dr. Oz!!
10 Responses to Dr. Oz Features Transradial Angioplasty and Stents
Maybe now that Dr. Oz has revealed this “newest medical breakthrough” and “radical new procedure” (the not-new-at-all radial cath), his cardiology colleagues in the U.S. might finally get onboard – due to patient preference and demand instead of actual real life evidence that you’d think would be driving most practice improvements.
As a heart attack survivor and two-time veteran of radial caths (here in Victoria, Canada, it is also the default PCI choice in most cath labs), I can vouch for this procedure’s superior appeal to your average patient, who can literally leap off the cath table and tapdance down the corridor (not recommended, but possible!) compared to those femoral access patients I hear from who are susceptible to known ongoing complications like bleeding, infections and pain.
I have long been curious about the puzzling reluctance of U.S. interventionalists to embrace this transradial access approach. Or, as a Lancet editorial recently asked, why are American cardiologists “stubbornly refusing to embrace this technique?”
As for the oft-heard rationale for this “stubborn refusal” – that U.S. cardiologists haven’t been trained in the technique during their fellowships – this training reality is clearly also true for docs throughout Canada, France, Italy, Spain, Japan, India and most other countries. In Norway, for example, almost 90% of all cases are transradial – and likely a huge chunk of these are now performed by cardiologists who were not trained in this technique during their fellowships.
Perhaps the arteries of all of those Canadians, French, Italians, Spanish, Japanese, Indians and Norwegians are just bigger and more appropriate for transradial access?!
I’ve been working in a CCL for 12 years and recently began doing radial approaches with our cardiologists (well, a few of them). A LHC from the RFA takes less than 10 minutes from numbing to pulling sheath. From the radial it can take nearly 30 minutes because, IMO, the access of the artery, spasm of the radial, and catheter manipulation exchanges, and patients seem to have alot of pain involved with it during the procedure which the Dr’s don’t like, so there is more time sedating the patient.
Lab Monkey — The experience of your cath lab is not borne out by the data we’ve seen in studies worldwide. In the hands of experienced operators, the length of time to perform a radial is no different than the femoral approach — if it were otherwise, we would not be seeing drops in mortality for STEMI treated via the transradial approach. Also most patients report that the radial approach is less, not more, painful. There are, of course, exceptions (and our Patient Forum has some of these stories) but we’re thinking that maybe this is the case right now since your lab is just beginning to do radials. There is a learning curve, but if the situation you describe does not change, we would suggest getting further training in the approach from more experienced operators (see our listing of transradial training courses. Spasm can be controlled and reduced through the use of a proper drug cocktail, correct equipment and patient selection. We’d be curious if you see a change in the results going forward.
I have had transradial entry angiograms twice, performed by Dr. Tremmel at Stanford Medical Center, with complete success. No complications. It was fast and the recovery time was far less and less complicated than the femoral entry. Maybe I’m an exception, but thought you would like this input
Appreciate the response, the radials that we do are entirely up to the physician. There have been a few that tried it and will not do it again and others who say it’s not worth the time because they lump their cases together on a single day and a 45 minute case, or several of them, just isn’t worth it to the Dr. Very rarely, now, a Dr. will do a radial on a patient and I think it is only when the patient requests it, and the Dr. is leaning towards the procedure being normal anyway.
Lab Monkey — If you (and your cardiologists) read through some of the expert interviews in our TransRadial Center, you’ll see that they all talk about the fact that starting a radial practice is a commitment to the approach, and it involves a lab-wide training program and a “radial first” attitude. Most agree that just doing radials sporadically will probably not result in increased proficiency with the technique.
69 yo male. I’ve had 2 angioplasties, one in 1995, and a combo “ad hoc” angioplasty/gram in 2007, and 2 other separate diagnostic since 1991. Is there any benefit to not using the femoral artery again and using the transradial method? How much potential for long term nerve damage or complications to the wrist could result that impact the hand, wrist or golf?
I agree that the cardiologist must be fully committed, trained and experienced in this approach to make it successful. I’m also of the belief that European etc techniques and outcomes are becoming more recognized as being a forward and advanced approach. Are there any considerations with using IVUS or FFR? Thanks.
Thomas — Whether or not to use the radial or femoral artery is a discussion you obviously need to have with the interventional cardiologist who will be doing the procedure. As you wrote, one would want the cardiologist to be experienced in this approach. There’s no impediment to using IVUS or FFR from the radial approach, but again…you want to have an experienced operator here. It may be that the cardiologist you know and who has been your caregiver is more comfortable with the femoral approach. And that’s fine. Even Dr. Kiemeneij, the inventor of transradial intervention, has told us that “Transradial is not a religion.” But experienced radial cardiologists are able to do extremely complex cases from the wrist.
While there are always risks for complications with any medical intervention, the potential for long term nerve damage or other complications is lower percentage-wise from the wrist approach. A couple years ago I interviewed a radial physician in Boston and asked him if he would perform a radial procedure on, let’s say, a concert pianist. And, surprisingly enough, he told me that he recently did just that! A well-known concert pianist had to have a procedure. The doctor laid out the risks and benefits of radial vs. femoral and the pianist opted for the radial approach…and all went well! Good luck in whichever approach you have. And thanks for your comments!
A month ago I had a heart attack and the cardiologist recommended placing a stent in the LAD. His first attempt was to use the transradial entry method. It was not successful! I was told later that he “nicked” the artery and a vascular surgeon had to be called in to repair the damage. Second attempt, performed by a different cardiologist, was successful. My questions are, how often does this mistake happen and how can I find out how much training the first doctor had in the radial procedure?
Sorry to hear of your complication. The transradial approach has shown significantly lower access site complications than the femoral (groin) approach, but no procedure is complication-free. That being said, you should be able to ask the cardiologist how many of these he has done. Estimates vary on the “learning curve” for radial (the number of cases a physician does AFTER training) but usually falls in at 50-100 minimum. That doesn’t mean the doctor’s 1st or 2nd cases will have problems; it’s just a measure one can use to see who is experienced. We have many interviews about these subjects with the leaders in this field in our Radial Center.