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May 2, 2010 -- 1:05pm EDT

Stents and Angioplasty from the Wrist: Texas Style
First Radial Procedure at Memorial Hermann Hospital in The Woodlands, TexasTwo years ago interventional cardiologist Dr. Sanjaykumar Patel joined the Sadler Clinic in The Woodlands, a suburb of Houston. He had taken his Fellowship at St. Vincent's Hospital in New York, with Dr. John Coppola as his mentor. Dr. Coppola is a strong advocate of the transradial approach, in which angioplasty and stents are delivered to the coronary arteries via a small puncture in the wrist. (Most of these procedures in the United States are done through the femoral artery in the groin.) You can read my interview with Dr. Coppola about why and how he started working this way -- suffice it to say: less bleeding complications and more patient comfort, with the patient able to sit up and walk almost immediately after the procedure.

When Dr. Patel arrived in Houston, radial procedures were not well-known. In fact, as he told me:

The multi-specialty practice I joined had six cardiologists. None of the six were doing transradial. They sort of had an idea of it...but all of them were surprised to know this approach. Even the 35 primary care and 50 internal medicine physicians whom I met during the interview, they were all surprised. For some of them, it was the first time they'd even heard about it.

Not only were the physicians and staff unfamiliar with doing these complicated interventions from the wrist artery -- the patients were as well:

You would see their mouths drop and they'd be surprised and amazed, "Is this even possible?" They would look at me suspiciously. The first few patients were like, "Doctor, is this experimental?" And I had to refer them to your web site, Angioplasty.Org, to show them the literature -- I always refer patients to it. It makes a difference big time. They go and they look and see all the people interviewed and these well-known cardiologists around the world talking about it, and it takes that anxiety away.

"Well-known cardiologists around the world" is correct -- in other countries, up to 50% of all catheter-based coronary procedures are done from the transradial wrist approach. The reason the U.S. is so far behind (only 5% of procedures are done this way here) has to do with training. Cardiologists learn the femoral approach in their fellowships and, unless they fortuitously land a position in a teaching program like Dr. Coppola's, they are unfamiliar with the radial approach. To learn it, they have to go back to the drawing board, attend a specialized training course, taking them out of their practice for a short while, and they have to do the procedure often enough to overcome the learning curve.

Of course, once they do learn, they become sought after, as Dr. Patel has in the hospitals where he practices. His first radial procedure is shown in the photo above (note the smiling patient!) and a story in the local paper about it made a big difference. Suddenly patients were interested and referring physicians were sending him their patients. That was two years ago; he has now done over a thousand radial procedures. As he told me:

I differentiated myself in the community because my doing transradial was a huge advantage for me in attracting the patient referrals -- because all my patients, they loved it!

There's been such interest that Dr. Patel is now running monthly transradial training courses for other cardiologists. As more cardiologists learn the technique and more patients find out that they may not have to lie flat on their backs for hours, use of the transradial approach in the U.S. is sure to make substantial increases.

You can read my complete interview with Sanjay Patel, MD, FACC in Angioplasty.Org's Transradial Center.

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