From Hand to Heart

Interventional cardiologists are traveling a new pathway in the fight against coronary artery disease.

Cardiac catheterization is the gold standard for defining the heart’s arteries and diagnosing blockages; a long,  thin tube is threaded through an artery or vein and into the heart, enabling a physician to visualize a blockage and open it with a balloon or stent. Now, a new radial approach––in which doctors obtain access to the heart through an artery in the wrist––is getting patients back on their feet faster than traditional methods.

With the standard approach, physicians access the heart through the femoral artery in the groin. “The advantage of the femoral artery is that it’s big, so it’s easy to puncture,” explains interventional cardiologist David Bartov, MD, FACC, of Associates in Cardiovascular Disease. “But while being a large artery is good in some respects, it also means it requires more time to heal.” In fact, patients must lay flat for six hours after the femoral procedure, often with a significant amount of pressure or a vascular plug applied to the artery in order to properly seal it. Since the radial artery in the wrist is so much smaller than the femoral artery and because it is very easy to compress with minimal pressure (it’s the artery you feel when you feel your pulse in your wrist), the risk of bleeding complications is much less.

The radial approach offers other conveniences as well. “Patients can sit upright right after the procedure. They’re not lying in bed for hours, which many patients find uncomfortable,” says Bartov. “If the radial catheterization is part of a diagnostic procedure, patients can go home after just two hours.” The radial artery is sealed by the patient wearing a small wristband, and the patient can ambulate immediately. “When you’re done, it’s like nothing happened–– nothing is left behind,” he says.

Radial access can be used both for patients with stable and unstable coronary artery disease. In fact, for the latter––patients who are having a heart attack––the procedure has been shown to provide a survival benefit as well. “In stable patients, the advantage of radial access is less bleeding and more convenience,” says Bartov. “But in patients who are having acute coronary symptoms, there is not only less risk of bleeding but also proven mortality benefits.”

Whether radial access is used in cardiac catheterization depends on both the patient and the physician. “The decision to use radial access comes down to what the patient wants and what the physician feels comfortable doing,” says Bartov, crediting his fellowship training at Yale School of Medicine––an early adopter of radial access––for his own comfort with using radial access. “It’s great that Overlook Medical Center is able to offer this kind of procedure to its patients, and deliver the benefits of advances in intervention technology. But all roads lead to Rome,” he says, “and whether we go in through the leg or the wrist, we’re going to get the information we need safely––that’s what’s most important.”