Compelling new evidence proves that a newer cardiac catheterization technique available at Stony Brook Medicine for two years — and just now beginning to be used nationwide — offers major benefits to patients. Stony Brook physician Luis Gruberg, MD, explains.
When would I potentially need a cardiac catheterization?
If you have symptoms of heart disease but are medically stable, your doctor may suggest cardiac catheterization as an elective procedure to check for blockages
in the coronary arteries and to evaluate how well the heart’s main pumping chamber is working.
Cardiac catheterizations also may be performed emergently in patients suspected of having a type of heart attack known as an ST elevation myocardial infarction (STEMI), in which there is a complete and prolonged period of blocked blood supply affecting a large area of the heart. Cardiac catheterization can be used not only to locate the blockage, but also to treat it.
What’s the alternative technique that is changing the way cardiac catheterizations are typically performed?
Most cardiac catheterizations in the U.S. have been performed by inserting a short needle into the femoral artery — a blood vessel located in the groin. Through the
needle, a straw-like tube called an introducer sheath is passed into the artery, and through the sheath, a long thin tube — the catheter — is carefully threaded through the blood vessel with x-ray guidance until it reaches the heart. There, contrast dye is injected through the catheter, and x-ray movies are created as the dye moves through the coronary arteries and chambers. Those x-ray images show us what’s happening in terms of disease. If we see blockages, we may be able to treat them by performing a percutaneous coronary intervention (PCI) using the same arterial passageway that already contains the catheter. A PCI may include an angioplasty, where a tiny balloon is inflated inside the blocked area to push plaque out of the way, or stenting, where a small spring-like metal scaffold is left inside the artery to help hold it open.
The alternative technique is similar in every way except for the point of access. Rather than going through the groin, the catheter is started in the radial blood vessel, which is located in the wrist. The benefits of transradial access are significant, but it takes a different skill set to do well and is only now becoming more widely used in the U.S. At Stony Brook, we’ve been doing transradial access on a large portion of our cardiac catheterization patients for over two years.
What’s the big news about transradial access?
We’ve learned that the difference it makes upon outcomes is huge. In a recent issue published in the journal Heart, researchers compared transradial versus transfemoral access by analyzing data from nine previous studies involving nearly 3,000 STEMI patients undergoing cardiac catheterization. What they found was that transradial access during coronary intervention (PCI) cut mortality by 47 percent, and major bleeding complications were reduced by 37 percent and access site complications by 70 percent. In the world of cardiology, that’s vital information.
Are there other benefits to patients?
Other pluses are a faster recovery and greater comfort. Because the risk of bleeding complications is so minimal with transradial access, patients are up and walking almost immediately and can go home faster. They can drive within 24 hours versus waiting five or six days with transfemoral procedures.
Can all cardiac catheterizations be performed transradially?
Determining the access point depends on the patient’s anatomy and the goals of the procedure. A small percentage of procedures (7 to 10 percent) that are started
transradially must be switched to transfemoral because of the individual anatomy of the blood vessel.
What’s next in transradial catheterization?
We’ll soon be participating in a National Institutes of Health (NIH) study comparing transfemoral to transradial cardiac catheterization in women with an acute heart attack.
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