The Way to the Heart May Be the Wrist

Atherosclerosis or clogged arteries may be treated through artery in the wrist rather than groin

(RxWiki News) Blocked arteries may be reopened through a catheter procedure. While traditionally the procedure has been carried out through the groin, access through the wrist may be a better route.

When arteries get clogged with a fatty buildup called plaque, individuals face a greater chance of having a heart attack or stroke. To open clogged arteries, doctors often turn to percutaneous coronary intervention (PCI) procedures that require threading a catheter to the blocked artery.

Although the groin has been the usual entry point for such a procedure, more doctors are finding that a way through the wrist has fewer complications in both men and women, according to a new study.

"Discuss new procedures with your doctor."

Dmitriy Feldman, MD, the study’s lead author and assistant professor of medicine at Weill Cornell Medical College in New York City, and other scientists reviewed data on almost three million artery-opening procedures in 1,381 centers from 2007 to 2012.

Investigators found that from 2004 to 2007, doctors used the radial artery in the wrist to reach the heart in fewer than one out of every 50 PCI procedures.

By the study’s end in 2012, nearly one out of every six PCIs was performed through a radial artery in the wrist. The use of the procedure increased 13-fold in a six-year period.

The researchers also noted that PCI procedures may be safer when carried out through the radial artery in the wrist rather than the femoral artery in the groin.

Bleeding complications occurred in 2.67 percent of the radial artery procedures, compared to 6.08 percent of the femoral artery procedures. Fewer vascular complications occurred in the radial artery group — 0.16 percent versus 0.45 percent.

Bleeding complications are a key concern in PCI because patients are often treated with blood-thinning medications that make it harder to stop bleeding after the procedure. The radial artery is smaller and located closer to the skin’s surface compared with the femoral artery, which is why it is easier to compress manually, Dr. Feldman said. This makes it easier to prevent or stop internal and external bleeding.

High-risk patients (those over age 75, women and people with acute coronary syndromes) benefited most from radial PCI. However, its use and growth of use was lowest in those patients, the researchers remarked. A "learning curve" is important in developing proficiency in radial PCI procedures, particularly in high-risk patients, Dr. Feldman said.

"Traditionally, femoral access has been taught and used in the United States for PCI, whereas the radial approach is frequently used in Europe," said Dr. Feldman.

Doctors in academic institutions and centers in the New England area are using radial PCI at a much higher rate than other centers in the United States, the researchers found.

The study was published June 10 in the American Heart Association journal Circulation.

The American College of Cardiology Foundation’s National Cardiovascular Data Registry funded the study.

Review Date: 
June 9, 2013