Langhorne, Pa., March 28, 2011 – Interventional Cardiologists at St. Mary Medical Center increasingly are using access through the wrist when performing a cardiac catheterization. Cardiovascular catheterization is a commonly used procedure to detect blockages in blood vessels in the heart and throughout the body and to clear blockages using angioplasty and stents to restore critical blood flow. In the majority of catheterizations, a thin tube called a catheter is inserted near the groin into a large artery at the top of the leg and threaded into the heart or peripheral arteries to the affected site. However, using more complex techniques and improved technology can allow specially trained cardiologists to perform cardiac catheterizations with radial access – in which the catheter is inserted through the wrist.
“I now use the radial approach in about 25 percent of my patients,” says Dr. Rakesh Shah. “Although I have performed catheterizations using radial access for more than 10 years, improvements in the technology, such as thinner wires that provide more support, and improvements in the stents themselves, allow us to now safely perform this procedure in even more patients.”
Dr. Shah elaborates that not only has the design of the catheters improved, but that some are now specifically designed for radial use. “We have successfully performed interventions via the wrist with catheters smaller than those considered standard size. A smaller size further reduces the bleeding risk and is less likely to compromise blood flow in the radial artery, which is already a small vessel,” says Dr. Shah.
Catheterization using radial access is technically more challenging for the interventional cardiologist, but the patient benefits in that the procedure is usually more comfortable and the risk of serious bleeding following the procedure is significantly reduced, according to the results of several recent studies. An article published recently in the Journal of the American College of Cardiologists states that “transradial coronary catheterization is safe, feasible, and effective.”
“A catheterization done through the wrist is a more comfortable experience for the patient and they can sit up immediately following the procedure,” says Dr. Ronald Fields, Medical Director of the St. Mary Heart and Vascular Labs. “Patients are now requesting their procedure be done this way, especially those who had a previous catheterization done through the leg area.”
After a catheterization using the leg (femoral artery) entry point, a patient must lay flat and remain still with pressure on the site for several hours following the procedure to allow the wound site to close and heal. Movement during this time period can cause the site to bleed and require additional hours spent lying still in bed to reduce the chance of a serious complication. Dr. Fields states that for elderly patients and those with chronic back pain or breathing difficulties, immobilization for several hours can be uncomfortable and problematic.
In comparison, the wrist artery (radial) is smaller, right under the skin and responds more quickly to pressure to close the wound site, which significantly reduces the potential for complications and bleeding. Recovery time also is shorter and most patients can return to normal activities more quickly.Access through the wrist does present challenges in that the vessel is smaller and may have more twists, especially in older patients. Therefore the procedure using radial access requires a more delicate approach by the cardiologist and can take longer to accomplish, which can slightly increase radiation exposure.
“If a patient is overweight or has a high risk of bleeding, this procedure offers a big advantage,” adds Dr. Fields. “It’s nice to have options and to be able to choose the right technique for each patient.”
It should be noted that the majority of cardiovascular catheterizations still are performed through femoral artery (leg) access. Not all patients are suitable candidates for radial access. Patients with small arteries, especially women, or those with anatomical twists, loops or spasms in the artery would likely be successfully treated with traditional access through the leg.
Cardiovascular-catheterization interventions are considered a safe and effective, minimally invasive alternative to open-heart surgery to open blocked arteries. Emergency catheterizations and angioplasties are performed to open an artery in the shortest possible time and thus minimize the damage caused by a heart attack.
Interventional cardiologists at St. Mary have a high success rate performing catheterizations using either method of access, but with radial access, now have a choice for treatment options and can determine which is best based on each patient’s need and circumstance.
“St. Mary is committed to providing advanced care and the best options for our patients,” says Thomas Nicosia, Cardiovascular Service Line Administrator. “The skills and expertise of our physicians in providing such a high level of care benefit all we serve in our community.”