August 19, 2008

Angioplasty Through The Wrist May Be Safer, More Effective

A recent major study has shown that the best route for artery-clearing angioplasties may be through the wrist rather than the traditional route through an artery in the groin.

Researchers said that angioplasties through the wrist can significantly decrease the risk of bleeding.

Currently, only about one in 100 angioplasties are performed through the wrist, but Monday's report from Duke University researchers may influence more specialists to use the method.

"In experienced hands, it can be done more," said Dr. Sidney Smith, heart disease chief at the University of North Carolina at Chapel Hill and a past president of the American Heart Association, who wasn't part of the study. "This approach, when done by experienced operators, has advantages."

During angioplasty, a tiny balloon is inflated at the site of the blockage, pushing back the clog. Doctors often also insert a mesh tube called a stent to keep the artery propped open.

Angioplasty is approved for both emergency and non-emergency procedures. Determining the best candidate for an angioplasty versus other treatments is hugely controversial. But once that decision has been made, the new study addressed whether the through-the-wrist route works as well.

Doctors traditionally prefer to perform angioplasties through the femoral artery in the groin because it is a larger blood vessel than the wrist's radial artery. But heavy bleeding and related complications are a risk, happening in anywhere from 2 percent to sometimes as many as 10 percent of patients.

In analyzing more than half a million angioplasties at 600 U.S. hospitals, Duke University researchers wanted to see how often wrist angioplasties were performed and the results. All were first-time, non-emergency cases.

Just 1.3 percent of the angioplasties were done through the wrist. Both methods were equally effective at clearing heart arteries, lead researcher Dr. Sunil Rao reported in the Journal of the American College of Cardiology: Cardiovascular Interventions.

The wrist method cut the bleeding risk by nearly 60 percent: Nearly 2 percent of patients treated the usual way bled, compared with slightly fewer than 1 percent of those treated via the wrist.

The heart association's Smith said training isn't difficult, and the need may be growing: Obesity can limit traditional access, plus more patients today have disease-damaged leg arteries.

"The procedure is not one that would be recommended for everybody," Smith cautioned. But, "there are definitely groups of patients where this can be done with the same results and fewer complications."


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