|
|
April
8,
2011 -- 6:50pm EDT
Transradial Wrist Angioplasty RIVALs Femoral
The
European cardiologists don't understand all the fuss in the U.S.
about wrist vs. groin, radial vs. femoral. They use
the wrist artery for angioplasty, stents and catheter access at
least half the time (many 80-90% of the time) and they can't understand
why,
in
the
United
States, it's only used in 5% of cases.
That may be changing as a result of an important
study presented this week at the American College of Cardiology Annual
Scientific Session
(the 60th! -- Happy Birthday ACC -- in 5 years you can qualify for
Medicare, assuming it still exists!)
For a comprehensive review of the study, dubbed RIVAL (RadIal Vs.
FemorAL Access for Coronary
Intervention Study), read my article on Angioplasty.Org, "Angioplasty
and Stenting from the Wrist Safe and Effective: The RIVAL Trial".
There was some disappointment when the RIVAL results
showed that one method was not superior to the other. You see, "radialists",
as they
call themselves, are very evangelical about the advantages
of the wrist as the access site for diagnostic and interventional
procedures. (They call those doctors who dismiss the wrist and are
"addicted" to the leg, "femoral-holics".) So the title of this new
study, RIVAL, is apt.
The radial technique was first described in
1989 by Montreal
cardiologist Dr. Lucien Campeau, but it's not been taught in medical
schools or most fellowships in the U.S. so, while virtually all
interventional cardiologists have been trained in the femoral approach
(using
the femoral artery
in the upper leg/groin area) which has been around since it was
perfected by Dr.
Melvin Judkins in the 60's, hardly any knew how to utilize the wrist.
Except a few
pioneering cardiologists, like Dr. Tift Mann, or Dr. John Coppola
who, after having a patient die from access-site bleeding complications after
a successful angioplasty, decided to go to India and learn this technique
from
Dr. Tejas Patel. Dr. Coppola describes this journey in his
exclusive interview in Angioplasty.Org's Transradial
Access Center.
That was less than a decade ago. Today things are different.
Equipment is smaller, catheters are thinner and can go through smaller
arteries, even a new stent (investigational in the U.S.) is called "a
stent-on-a-wire", made by Svelte
Medical. Imaging manufacturers are also getting into the act. Toshiba
Medical just announced a new cath lab installation "optimized
for the transradial approach". However, with new and very potent antithrombotic
drugs that can help prevent clotting during interventional procedures,
especially in STEMI, excess bleeding, especially at the catheter access
site, has become a concern.
Enter transradial: lower (or no) bleeding complications,
increased patient comfort, because there is no need to lie still
for hours, with heavy pressure on the femoral artery, or even need
for a vascular closure device. And with smaller, thinner equipment,
almost any complex procedure can be performed from the wrist. The
only problem is very very few cardiologists can do a radial procedure.
That too is changing, and I talk about that in my
article too.
So very soon, the joke Robin Williams tells about his
heart procedure ("Who
knew that the way to a man's heart was through his groin?") may be...well,
he'll just have to work the wrist into it somehow.... ;-)
|
|
|