Lifewatch: Unclogging arteries through the wrist

Reported by Claire Hosmann - bio|email
Posted by Debra Worley - email

(WECT) - Every minute, somebody dies from a heart attack.  The statistics are alarming, but now doctors are using a new pathway to help find heart disease before it kills.

Cardiologists are now using the wrist instead of the groin for angiograms.  Using transradial catheterizaion, cardiologist Sanjay Patel goes through the radial artery. A catheter ropes its way through the artery into the heart, in search of blocked arteries.

If there is a problem, a stent would be placed right away.

Doctor Patel says wrist angiograms are harder to perform because the artery is smaller, but in one study they cut the need for blood transfusions by 50 percent.

"To our experience, nobody could really bleed to death in the wrist, compared to the groin," said Dr. Patel.

The risk of nerve damage is greatly reduced, and instead of laying down for six hours after surgery, patients sit up immediately.

"In fact, they can walk right out of the cath lab after the procedure," said Dr. Patel.

Although wrist angiograms are used in fewer than 5% of patients in the US, 40-50% of all angiograms in Europe are done this way.

For more information, please contact:
Sanjay Patel, M.D.
(281) 297-7648

BACKGROUND: The coronary arteries are vessels that constantly supply blood to the heart, which pumps almost 2,000 gallons of blood throughout the body each day. If plaque builds up in these arteries, life-threatening blockages can develop. Blockages reduce blood flow to the heart and cause chest pain or heart attack. Many patients who experience plaque buildup in the coronary arteries must undergo surgery to fix the problem. These types of procedures are called percutaneous coronary interventions (PCI), and the most common intervention is an angioplasty. Angioplasty involves threading a slender, balloon-tipped tube called a catheter through an artery in the groin and eventually into the trouble spot in artery of the heart. The balloon is then inflated to compress the plaque and widen the artery. Often, a metal stent -- or wire mesh tube -- is left in the area to keep the artery open. According to the American Heart Association, over 1.3 million angioplasties were performed in the United States in 2006, the most recent year for which data is available.

RISKS: Risks of angioplasty include bleeding from the artery where the catheter was placed, damage to the artery, allergic reactions, irregular heartbeat, kidney damage from the dye used in the procedure, heart attack and stroke. If angioplasty is done through the leg, the patient has to lie down quietly for several hours after the procedure to minimize the risk of bleeding. Since the risk of bleeding is lower for angioplasty through the wrist, patients who are operated on using this method can be mobile immediately. To reduce the risk of blood clot formation and stroke, patients are usually prescribed aspirin after surgery.

A NEW AVENUE TO TREAT HEART DISEASE: Although the majority of angioplasties are performed through the femoral artery in the groin (upper leg), a newer way to perform angioplasties uses the wrist as an entryway. Although fewer than 5 percent of angioplasties are performed this way, several recent studies suggest it's a safer alternative to the traditional procedure. In one Duke study, researchers analyzed more than 500,000 angioplasty procedures in a national registry. They compared success rates, bleeding complications and vascular complications between angioplasties performed through the wrist and the groin. Results show 1.32 percent of the procedures were performed through the wrist, but the risk of bleeding complications in the wrist method was nearly 60 percent lower than in the traditional method -- 2 percent of patients treated through the groin had complications while fewer than 1 percent of those treated through the wrist did. The difference in risk was greatest in patients under 75 years old, women, and patients undergoing PCI for acute coronary syndrome. Success rates for the two procedures were similar. A more recent study that analyzed 5,000 angioplasties at Baptist Cardiac & Vascular Institute in Miami, Fla., found only 0.3 percent of patients who underwent wrist angioplasty experienced bleeding complications.

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