As they attempt to open clogged heart arteries, more US doctors are taking a new route and threading a catheter through the wrist, rather than the groin, a new study finds.
This is because entering the radial artery in the wrist is linked to fewer bleeding complications than the traditional route through the femoral artery in the groin, according to the study, published June 10 in the journal Circulation. The artery-opening procedure is called percutaneous coronary intervention (PCI) or coronary angioplasty.
"Traditionally, femoral access has been taught and used in the United States for PCI, whereas the radial approach is frequently used in Europe," study lead author Dr Dmitriy Feldman, an assistant professor of medicine at Weill Cornell Medical College, New York Presbyterian Hospital department of medicine, said in a journal news release.
He and his colleagues studied data on nearly 3 million artery-opening procedures and found that bleeding complications occurred in about 3% of the radial artery procedures, compared with about 6% of the femoral artery procedures.
Bleeding complications in patients
Wider use of the wrist-route procedure could improve safety of the artery-opening operations, the study authors said in the news release. Bleeding complications are an important concern in these procedures because patients are often taking blood thinners that make it harder to stop bleeding after the procedure.
The radial artery is smaller and located closer to the skin's surface than the femoral artery, which makes it easier to prevent or stop bleeding, the researchers explained.
The research team analyzed artery-opening procedures conducted at nearly 1 400 US centres between 2007 and 2012. By the end of 2012, nearly one of every six procedures was performed through the wrist's radial artery. That's a 13-fold increase from 2004-2007, when fewer than one of every 50 PCIs was performed through the radial artery.
The greatest benefits of wrist artery PCI were seen in high-risk patients, such as those over age 75, women and patients with acute coronary syndromes, the investigators found. However, these patients are least likely to undergo the wrist-route procedure, the study authors said.
The researchers also found that the use of radial PCI is much higher at academic institutions and centres in New England than at other centres in the United States.
The US National Heart, Lung, and Blood Institute has more about coronary angioplasty.