image: This infographic from the article outlines opening clogged heart arteries via the radial artery in the wrist is becoming more common. view more
Credit: Source - American Heart Association's journal <i>Circulation</i>: D. Feldman
The way to a man's heart may be his wrist.
More U.S. doctors are unclogging heart arteries (in men and women) by entering through the radial artery in the wrist, which is linked to less bleeding complications than the traditional route through the groin, according to new research in the American Heart Association journal Circulation.
Doctors reopen blocked arteries by threading a catheter through the femoral artery in the groin or the radial artery in the wrist in a procedure called percutaneous coronary intervention (PCI).
For the study, researchers examined data of almost 3 million artery-opening procedures in 1,381 centers in 2007-12. They found:
- In 2004-07, doctors used the radial artery to reach the heart in less 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 — a 13-fold increase.
"Traditionally, femoral access has been taught and used in the United States for PCI, whereas the radial approach is frequently used in Europe," said Dmitriy N. Feldman, M.D., the study's lead author and assistant professor of medicine at Weill Cornell Medical College, New York Presbyterian Hospital Department of Medicine, Greenberg Division of Cardiology.
Wider use of the wrist-route procedure, particularly in high-risk patients, could improve PCI safety, researchers said.
Bleeding complications are an important 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, Feldman said. This makes it easier to prevent or stop internal and external bleeding.
Researchers found:
- Bleeding complications occurred in 2.67 percent of the radial artery procedures, compared to 6.08 percent of the femoral artery.
- Fewer vascular complications occurred in the radial artery group: 0.16 percent vs. 0.45 percent.
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 is lowest in those patients, researchers noted. A "learning curve" is important in developing proficiency in radial PCI procedures, particularly in high-risk patients, Feldman said.
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, researchers found.
Co-authors are Rajesh V. Swaminathan, M.D.; Lisa A. Kaltenbach, M.S.; Dmitri V. Baklanov, M.D.; Luke K. Kim, M.D.; S. Chiu Wong, M.D.; Robert M. Minutello, M.D.; John C. Messenger, M.D.; Issam Moussa, M.D.; Kirk N. Garratt, M.D.; Robert N. Piana, M.D.; William B. Hillegass, M.D.; Mauricio G. Cohen, M.D.; Ian C. Gilchrist, M.D.; and Sunil V. Rao, M.D.
Author disclosures are on the manuscript.
The American College of Cardiology Foundation's National Cardiovascular Data Registry funded the study.
For the latest heart and stroke news, follow us on Twitter: @HeartNews.
For updates from Circulation, follow @CircAHA.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at http://www.heart.org/corporatefunding.