Interventional cardiologists follow a new path to patients’ hearts—starting at the wrist

Nov. 28, 2012
The goal for interventional cardiologists has been the same for years: to safely clear life-threatening blockages in a patient’s coronary arteries without resorting to major surgery--before precious heart muscle is damaged. 

A different approach
But, like those handy directions on your smart phone, it turns out there’s more than one way to get to there. Experts with University of Minnesota Physicians Heart at Fairview are offering a different approach to clear blocked arteries.

In Minnesota and across the United States, most angioplasties take place in a heart catheterization lab. It usually starts by making a small incision in the groin. Then a thin, wire is threaded up the femoral artery all the way to the heart. A catheter is advanced over the wire and positioned in the mouth of the coronary artery. Contrast is injected to help the interventional cardiologist see any blockages. Then, a tiny balloon is inflated at the end of the wire to open the vessel. A stent may be placed to keep the artery propped open.

In the United States, 90 percent or more of these procedures are done using the femoral artery approach. The procedure is widely considered to be safe and effective.

Drawbacks to more common approach
But there are some drawbacks:
  • Following the procedure, patients must lie flat on their back for up to 10 hours or more.
  • Compression is applied to the incision site for up to an hour to protect against bleeding.
  • Complications from bleeding, although rare, can require blood transfusion or other special treatment prolonging the hospital stay and increasing costs by thousands of dollars. Bleeding can also be a life-threatening emergency.
  • Because patients have to lie flat on their back, they can’t use the toilet, they can’t walk and eating is difficult.

Tapping into an artery in the wrist
However, interventional cardiologists at University of Minnesota Physicians Heart at Fairview are now performing more heart catheterization procedures by tapping into an artery in the wrist.

The radial artery approach can have a dramatic impact on the patient’s experience. Randomized clinical studies have shown this approach carries a lower risk of bleeding complications than the femoral approach. Following the procedure, the wrist is wrapped with a special compression wristband to maintain pressure on the incision. The patient can then be up, use the bathroom, walk and eat as appropriate. The wristband is usually off in four hours and the patient can often go home instead of staying in the hospital overnight.

A recent study found the radial artery approach may be more effective then the femoral approach as a treatment for an active heart attack.

Outside the United States, the radial approach is far more common. In parts of Europe, Asia and even in Canada, it’s estimated that 50 to 60 percent of all heart catheterization procedures are done using the radial artery approach.

A growing local trend
Although the rate may be closer to 10 percent in the United States, interventional cardiologists are beginning to buck that trend in the Twin Cities.

At Fairview Ridges Hospital in Burnsville, Minn., about 44 percent of its heart catheterization cases are performed using the radial approach. Nearly 23 percent are performed this way at Fairview Southdale Hospital in Edina. Three University of Minnesota Physicians interventional cardiologists say they use the technique in 85 percent of their cases. It’s also performed at the University of Minnesota Medical Center, in Minneapolis.

Experts say the vast majority of patients who are candidates for angioplasty would be eligible for the radial approach. Patients considering angioplasty should inquire with their doctor to see if the radial technique is an option available to them.
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