In treating artery blockages, for decades now, doctors have been increasingly relying on catheterization, a procedure involving the threading of a tiny tube through the arterial system to the heart.
This catheter-based therapy, also known as “interventional cardiology,” utilizes the body's circulatory system which is essentially the body's "highway" to deliver medicine and devices to affected areas, avoiding more risky standard open surgery.
When attempting to access the coronary arteries to clear a blockage with a balloon, or place a stent to hold the artery open, the most often used entry point to the circulatory system has been the femoral artery (main artery in the leg). This femoral approach has been the gold standard method in which most catheter-based procedures are done in the U.S.
But, in the late 1980's doctors were discovering a shorter route to the blockages and one that carries less complications and more comfort for the patient. It's the radial artery in the wrist. While a bit smaller than the femoral artery, the radial is still large enough to allow today's lower profile catheters a smooth path through the coronary anatomy. In fact, the radial artery is harvested and used in coronary artery bypass grafts on occasion.
With the radial technique, also called transradial catheterization (TRA), there is less bleeding.
A number of studies show that bleeding following angioplasty procedures is a predictor of worse outcomes. For the patient, the advantage is that there is no longer any need to lie flat and still for four to six, or experience what can be a painful manual compression of the artery to curb the bleeding. It is also a big advantage to those with back pain. Because of the simpler healing process for the arterial puncture in the wrist, patients leave the catheterization lab and are able to sit up and walk almost immediately. In some cases, certain patients may also be discharged home without a hospital stay.
Each year, more than a million Americans have this procedure and they rarely cause serious complications. I've had patients who have had both procedures and prefer the transradial approach almost universally.
St. Mary's Medical Center was the first hospital in the region to embrace transradial catheterization more than five years ago and remains the leader in the area. About half of the cardiac catheterization procedures performed at St. Mary's are radial access cases, compared with about 15 percent of patients at hospitals nationally, despite the fact that 90 percent of patients in need of cardiac catheterization are candidates for the radial option.
Why so few?
There are several reasons for this low adoption rate. Lack of economic incentives due to the reimbursement structure and low patient awareness of this alternative plays a role, but mostly there is a lack of trained cardiologists. Only a relatively small percentage of interventional cardiologists in the U.S. are trained in the transradial technique.
This is changing as more practices begin to see the advantages in lower complication rates (which can be expensive to manage), as well as increased patient satisfaction and cost-savings.
Finally, It's very important to know the early heart attack symptoms so you can take action to help get treatment as soon as possible. Warning signs include:
• Chest pain or discomfort
• Abnormal discomfort in the arms, back, neck, jaw or upper abdomen, especially with exertion.
• Shortness of breath with less exertion than usual
• Nausea, lightheadedness or cold sweats
• Unexplained fatigue
Not all people have the same symptoms and symptoms can be subtle, especially in women. If you suspect it could be experiencing a heart attack, please don't delay, don't try to drive yourself or someone else to a hospital – call 911 immediately.
Dr. Daniel Dunker is a cardiologist in practice at St. Mary's Medical Center in Blue Springs and can be reached at 816-220-1117.