Wrist-cutters: More Doctors Are Unclogging Heart Arteries Via Wrist Angioplasty
More cardiologists are switiching to wrist-based angioplasty, a medical procedure that uses blood vessels in the forearm to remove blockages in heart arteries, according to study in the American Heart Association journal Circulation.
The heart supplies blood and oxygen throughout the body, but nowhere is this function more important than the heart itself. When plaque builds up inside the arteries that supply the heart with nutrients, it can weaken the organ and result in corornary heart disease, the leading cause of death in the U.S.
Doctors can repair partially clogged arteries with a clinical technique called angioplasty, also referred to in the medical field by percutaneous coronary intervention (PCI). The traditional approach involves inserting an skinny tube with a balloon attached to the tip into the femoral artery, a major blood vessel accessed through the groin area. The tube-guided balloon is then navigated from the groin to the afflicted blood vessel in the heart. Once it has reached its destination, the balloon is inflated to expand and reopen the clogged vessel.
Another route to the heart can be accessed via the wrist's radial artery. A study, led by Dr. Dmitriy Feldman of Weill Cornell Medical College, found that more doctors are choosing this path.
Feldman and his colleagues examined data from nearly 3 million procedures conducted at over 1,300 medical centers from 2007 to 2012. They found the number of wrist-based angioplasties jumped 13-fold during the time period.
"Traditionally, femoral access has been taught and used in the United States for PCI, whereas the radial approach is frequently used in Europe," said Feldman. He and his colleagues note that the rise in radial artery procedures is likely due to more medical schools including it in their training programs since 2007.
Whereas only one in 50 doctors preferred radial arteries in 2007, this figure has risen to one in six operations in 2012. Doctors in New England and the Mid-Atlantic states were about twice as likely to perform the radial artery approach compared to other parts of the country.
Why Wrist Access Is Gaining Popularity during Heart Catheter Procedures
The change in preference may also be due to the fact that radial artery-based procedures are just as effective at fixing coronary heart problems, but result in fewer bleeding complications. Unwanted bleeding can occur during angioplasty because patients with cardiovascular disease are often treated with blood-thinning medications.
Women, people over the age of 75, and those suffering from acute coronary syndrome have a higher risk of developing bleeding and vascular complications during angioplasty.
The researchers found that this subgroup profited the most from switching to the wrist-based procedure, but paradoxically were the least likely to receive this treatment.
The authors conclude that a wider adoption of the radial artery approach "presents an opportunity to potentially improve overall safety."
Source: Feldman DN, Swaminathan RV Kaltenbach LA, Baklanov DV et al. Adoption of Radial Access and Comparison of Outcomes to Femoral Access in Percutaneous Coronary Intervention An Updated Report from the National Cardiovascular Data Registry (2007-2012). Circulation. 2013.