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Heart procedures called cardiac catheterization have been performed for many years. Cardiac catheterization, coronary angioplasty, and stenting are some of the most important ways to diagnose and treat patients with coronary artery disease (the #1 cause of death in the United States). Traditionally this procedure is performed through the groin or femoral artery, but now there is a less invasive, safer, and more comfortable technique for doing these procedures: using the wrist or radial artery. The physicians at Heart and Vascular Care are experts at performing these procedures through a single needle stick in the blood vessel of the wrist (radial artery).

Werner Forssmann, MD was a German physician who in 1929 performed first human cardiac catheterization on himself using X-ray! He inserted a catheter into a vein in his forearm then into the right ventricle of the heart. He used this technique to calculate the heart function of his patients and administer drugs. For this work he received the Nobel Prize in Medicine in 1956

 

In one of the most exciting inventions in modern medicine, in Zurich 1977, Andreas Gruntzig, MD was able to use wires and a small balloon to open (angioplasty) a blockage in a heart artery with just a small needle stick in the patient’s groin. As the field of interventional cardiology developed, in 1992 Ferdinand Kiemeneij, MD (the “Father of trans-radial intervention”) in Amsterdam was able to using just a needle stick in the artery of the wrist (radial artery) perform balloon angioplasty and stents (metal tubes) on blocked heart arteries for his patients. He developed this technique to reduce the risk of bleeding.

 


SO WHY DO RADIAL ARTERY (WRIST) PROCEDURES HAVE SOME ADVANTAGES OVER FEMORAL ARTERY (GROIN) PROCEDURES?
Radial artery cardiac catheterization, balloon angioplasty, and stent placement offer less complications, increased patient comfort, and may decrease healthcare costs.

ADVANTAGES of RADIAL (Wrist) OVER TRADITIONAL FEMORAL (Groin) PROCEDURES
Less complications
• Less bleeding after heart stent placement
• If patient is having a severe heart attack then possibly more chance of surviving

Increased patient comfort
• Immediately after procedure, the patient can be in a seated position or can move body except for hand that was used for procedure
• Quicker discharge: Many patients able to go home in 2-3 hours after procedure if no stent placed. Also, some patients with stents placed can go home after about six hours

Healthcare costs
• Less bleeding complications
• Often no overnight stay for patients receiving heart stents.


TECHNIQUE: When a patient and their cardiologist decides to perform a cardiac catheterization they will discuss the method and location of accessing or entering one of the blood vessels of the body. Most commonly this is done in either the femoral artery in the groin or the radial artery in the wrist. From this access site the cardiologist can insert catheters that go to the heart and are able to look for heart artery blockages and also treat those blockages with balloon angioplasty and stents. These procedures are done at a hospital in the Cardiac Catheterization Laboratory (Cath Lab). After the patient arrives at the Cardiac Cath Lab they are changed into a hospital gown and then placed on the procedure table. They are given light or moderate sedation with usually intravenous Fentanyl and Versed but are not under full anesthesia typically. If a radial or wrist artery procedure is planned the cardiologist gives local anesthetic agent to the wrist and then using a small needle is able to place a sheath in the wrist. From that access site they are able to image all the arteries of the heart and perform balloon angioplasty and stents.

The procedure usually takes about 30 minutes to determine if there is a blockage and if a stent is necessary another approximately 30 minutes.

 

Animation of atherosclerosis development in coronary artery. This can lead to angina or heart attack.
[Courtesy of Scottish Center for Telehealth and TeleCare]

Description of heart catheterization procedure done through radial artery of arm.
[Courtesy of Scottish Center for Telehealth and TeleCare]

Animation of treatment of coronary artery blockage with balloon angioplasty and stenting.
[Courtesy of Scottish Center for Telehealth and TeleCare]


After the procedure the sheath in the radial artery is removed and a compression device that looks similar to a wristwatch is used to prevent bleeding. At that point the patient can move all the parts of their body except the arm used for the procedure. This is a distinct advantage over the groin or femoral artery access in which the patient may have to lie almost totally still for up to 6 hours. Once bleeding is controlled in 1-2 hours the patient is able to go home or to a hospital room if a stent was placed. Some patient receiving stents are able to go home the same day.
The cardiologists at Heart and Vascular Care perform radial cardiac catheterization, balloon angioplasty, and stents at Northside Hospital-Cherokee, Northside Hospital-Forysth, and Emory Johns Creek Hospital. We feel this procedure is safer, more comfortable, and cost-effective for appropriate patients.


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