Patrick J. Skerrett

From the wrist to the heart: new angioplasty method is safe, effective

Clearing a clogged or blocked heart artery once required open-heart surgery, followed by a weeks-long recovery period. Angioplasty, first done in 1977, offers a simpler alternative that doesn’t require surgery or much recovery. Results from a large international trial provide strong evidence for an even easier type of angioplasty that is done through the radial artery in the wrist instead of the femoral artery in the groin.

The radial artery supplies the hand with blood. It’s the artery you press when you take your pulse. Performing angioplasty through the radial artery was first introduced in the Netherlands in the early 1990s. This artery offers ready access to the heart and is sometimes easier to get at. Doing angioplasty through it also tends to cause less bleeding around the puncture after the procedure is over than the femoral approach.

Radial artery angioplasty has become popular in Europe and Japan, where it is used almost as often as the femoral approach. Cardiologists in the United States have been reluctant to embrace it.

An international study called RIVAL compared the two approaches and found they were equally successful at opening the troubled heart artery (95%). Rates of death, heart attack, and stroke within 30 days of the procedure were identical (3.2%). But there were fewer cases of bleeding around the angioplasty entry site with the radial approach, and it also appeared to be more effective than the femoral approach for treating people in the midst of a heart attack. The results were presented yesterday at the American College of Cardiology meeting in New Orleans and published in The Lancet.

One big plus of the radial approach is that a person doesn’t need to lie still for several hours after the procedure to make sure the bleeding has stopped. In fact, people who have radial artery angioplasty can often go home the same day, as we write in the April 2011 Harvard Heart Letter.

Radial artery angioplasty isn’t a miracle worker, and it isn’t for everyone. But when done by an experienced team, it’s a good alternative to standard angioplasty. You can read more about radial artery angioplasty in the December 2008 Harvard Heart Letter.

Comments:

  1. ashby jones

    I have a total calcium artery score of 537 with 380 of this in the LAD. I am 70, a workout nut for 45 years, BMI = 20; LDL = 76; HDL = 65, nonsmoker forever, drink a glass of wine a day. Had test done at UCLA Harbor in response to an ad, not on a doc’s recommendation. The results scared me. Am I a candidate for angioplasty? By the way I have never had a heart attack or angina. I do have ventricular tachycardia but am told it is in the “low third” – a run of 5-10 beats every three or fours days. I take a statin which I’ve been on for 10 years.

    Thank you so much for your response.

  2. Al from UK

    I had a radial angioplasty procedure last week, and I was discharged the following day. There is some swelling in my right hand, four days after the procedure and some pain up the arm (requiring me to take painkillers), but otherwise I feel fine. It’s a little bit painful typing this comment, but I have to exercise my hand!

    I needed morphine during the procedure as I experienced considerable pain at one point throughout my arm.

    It was a difficult operation which took over two hours, as a major artery was completely occluded. Two stents were inserted. But there were no complications.

    For your information, I had the operation in England, where I live (therefore I have no idea of the cost, due to our NHS system here).

    • Syl - Chicago

      Al,

      I’m glad you’re doing well! My mom is having the same procedure in about a week, and the information you provide was so helpful! I go to admit, I’m still nervous about the whole procedure. My mom has two stents, and now the artery is blocked again. This time the doctor perscribed a medicine to unclog the 95% clogged artery. Again, thank you for the informaton!

  3. Maude

    This technique is already use in Quebec (Canada) at Institut universitaire de pneumologie et cardiologie de Québec for a long time now (more than 10 years). It’s the most often technique used for angioplasty. The results are great and so much easier for patient. In most of the cases the patient got back home in the same day.

  4. Johnny Palmer

    Does this mean we can expect less people to be eating healthy and exercising now that surgery is easier and cheaper?

    • Patrick J. Skerrett
      P.J. Skerrett

      Johnny — That would be a cynic’s take on this development. I don’t think so — even if radial artery angioplasty is a bit easier for people than the more traditional approach, it still isn’t a walk in the park. There are risks, like damage to the nerves in the hand, just as there are for femoral access angioplasty. Keep exercising and eating healthful foods.

      PJ Skerrett