Unclogging Blocked Arteries Via the Wrist

Angioplasty approach may offer clinical benefits for certain patients

Angioplasty, a nonsurgical treatment used to open narrowed coronary arteries to improve blood flow to the heart, traditionally has been done through femoral (leg) artery access in the patient’s groin area.

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During the past several years, interventional cardiologists at Cleveland Clinic’s Miller Family Heart & Vascular Institute also have begun offering another option: Using the radial (arm) artery in the wrist as the entry point for the procedure.

Cleveland Clinic’s interventional cardiologists now perform about 15% of angioplasties using the radial approach each year

“The radial approach, which is more technically demanding because of the small size of the arm artery compared to the leg artery, is associated with less bleeding and more patient comfort,” says Stephen G. Ellis, MD, Cleveland Clinic’s Head of Invasive and Interventional Cardiology.

Now a new, large nationwide study comparing the radial versus the femoral approach in angioplasty (also called percutaneous coronary intervention [PCI] has garnered further support for the potential benefits of gaining access to coronary arteries through the wrist. The study, presented at the 24th annual Transcatheter Cardiovascular Therapeutics scientific symposium in late October found that:

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  • In patients who underwent angioplasty within 12 hours of experiencing a serious type of heart attack called a STEMI, arterial access through the wrist rather than the groin resulted in greater clinical benefits—including a significantly lower incidence of major bleeding and fewer access site complications.
  • Procedures done via the wrist significantly decreased intensive care unit (ICU) stays.

The relative benefits of radial versus femoral angioplasties continue to be hotly debated within the cardiology community, and the vast majority still are performed through the leg artery. Not all interventional cardiologists are trained in radial access angioplasty, and due to the increased technical complexity, the approach is more time-consuming. There also can be challenges associated with the types of catheters—the long, narrow, flexible tubes inserted under the skin and into the artery to perform angioplasty—available to perform the procedure through the smaller-diameter arm artery.

Dr. Ellis encourages patients to discuss their options with their physician, but he emphasizes that not all patients are candidates for angioplasty through the wrist, in which case access through the groin is preferred. “For example, sometimes the radial artery is not large enough to accommodate the type of equipment needed to treat the patient,” he says. “Oftentimes, however, it is simply patient and physician preference.”

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