Transradial Angioplasty Video Transcript
Hi, I’m George Broderick – Medical Director of Cardiology at Good Samaritan Hospital and Dayton Heart & Vascular Hospital at Good Sam. I’m here to describe to you the cardiac catheterization procedure via radial access or a radial artery heart catheterization that we are doing more and more at Good Samaritan Hospital. Currently the procedure of cardiac catheterization via radial access in the United States is done about 3-4% of the time. At Good Samaritan at this point, we are over 30% of the time performing radial artery catheterization, and some of our operators are performing them up to 80-90% of the time. The main benefit of radial artery catheterization is lower complication rates and patient satisfaction. Several large trials have been performed – the most recent trial called the RIVAL trial which was presented at the most recent Heart Association meetings with over 7,000 patients randomized to either femoral versus radial artery access. That trial showed that overall there was no change in mortality or death from myocardial infarction from either the femoral versus radial access approach, but there was a marked drop in bleeding complications with radial access compared to femoral access. A marked drop in transfusion need, marked increase in patient satisfaction and also, in the subset of patients with ST-elevation myocardial infarctions, there was an improvement in cardiovascular mortality and improvement in total mortality with patients who underwent radial access. This was a very important pivotal trial using over 7,000 patients showing the ease and convenience of radial access approach to cardiac catheterization. Currently, in high-volume centers such as Good Samaritan Hospital with radial access catheterization being performed frequently, this really helps our patients.
The technique is difficult to learn, but experience catheterization operators can learn relatively quickly. The patient’s are prepped initially with the Allen’s test to make sure there is dual radial and ulnar blood supply to the wrist and, once that is established, a small catheter is inserted, usually a 5-French catheter (or a 6-French catheter can be inserted), into the radial artery using a small Angiocath and wire technique. Through the sheath that is left in the radial artery, all the catheterization procedures can be performed – such as cardiac diagnostic catheterization, evaluation of aortic and mitral valve disease and coronary angiography. Through there, as well, simple and even more complex coronary interventional procedures, multivessel coronary stenting and aspiration thrombectomy and other procedures: intravascular ultrasound and other procedures that we do in the catheterization laboratory through the femoral access can also be done via the radial access. At the termination of the procedure, the radial sheath is removed, a small compression device is placed on the wrist, and the patient is taken out of the room. The compression device is removed in 1-2 hours, even on significant blood thinners, and the patient’s bleeding risk has markedly dropped, and their convenience is increased. So we have found, as others nationally, that this is an excellent technique for patients to use that improves outcomes, improves patient compliance and satisfaction and lowers bleeding complications.
Hi, I’m George Broderick – Medical Director of Cardiology and interventional cardiologist at Good Samaritan Hospital and Dayton Heart & Vascular Hospital at Good Sam. Today I’m gonna be talking about doing cardiac catheterization, angioplasties and stent procedures through the wrist artery instead of down through the groin. This is called cardiac catheterization via radial access – that’s the radial artery – the wrist artery – and it’s an excellent boon for patients in terms of their safety and convenience.
Heart catheterizations or coronary angiogram – coronary refers to heart, angiogram is an x-ray dye picture that we take – the procedure is used to look for severe coronary artery blockages – that is the main reason. What other reasons to go in? What most of them are talking about is looking at heart artery blockages. If someone is having a lot of bad chest pains, has an abnormal stress test. So the heart catheterization is being used to look for severe heart artery blockages that may benefit either from open heart surgery, bypass surgery or the balloon and stent procedure to open the artery up with a stent to improve symptoms and sometimes to improve patients’ lifestyles and make them live longer. So, the way to get in there, one uses these tubes – the heart catheterization – to put a tube or a catheter up into the arteries, inject x-ray dye and take x-ray pictures. And that’s what the heart catheterization does. Patients are given mild sedation, laid on a heart catheterization table which is basically an x-ray table, and the x-ray machine moves around the heart and the body as we take various pictures. We get beautiful pictures that way – and it’s the best pictures we have – it’s called the “gold standard” for looking at heart arteries. And from that, then we can determine what needs to be done with the heart arteries, whether just medicine alone or a stent procedure or even open heart surgery, and that’s why we do the heart catheterization.
About 20 years ago, people in Europe and India and other areas started doing the procedures through the artery in the wrist, and it’s where you feel your pulse, and you…everyone can feel their pulse in their wrist and feel where that artery is lying.
And through that, and the techniques that we do nowadays, you could put smaller tubes through that wrist artery up into the heart and pretty much perform all of the procedures – the pictures that we have to take of the arteries and even put stents or the balloon angioplasty procedures in through the wrist into the heart to fix the artery. And that’s been a tremendous advantage for patients.
Patient: On the day of catheterization, I went in shortly after lunch, and went through the normal prep process. Uh, and went into the operating room, I guess it would be, where they do the procedure. And Dr. Broderick was there. Uh, he, along with the staff, talked me through what was going to happen, what I should expect….
DURING PROCEDURE: Broderick: I’m going to inject some x-ray dye to see how the heart is pumping.
Patient: And the procedure that he used was actually going through the wrist which was uh really great compared to some of the stories I’ve heard about going through the groin. And uh, but it went really well. Uh, I was in there. He did put the stents in. I was out in a very short period of time.
BRODERICK: The big advantage is less bleeding complications. That leads to better outcomes for patients who have the procedure done through the wrist compared to the groin. The groin procedure still is very safe, but the access site or doing the catheterization procedure through the wrist is safer. The other thing is patient convenience. A patient can literally get up and walk out of the catheterization lab a lot of times when the procedure is done here because we close it very quickly and safely. The patient can’t do that with the groin procedure because they have to be placed on the bed and, and taken out and have to lay flat for 6 hours or so. So, those are the big uh reasons that proc…doing the procedure through the wrist is much better – safety and convenience for the patient.
Patient: I have family members who have had the catheterization through the groin, and there is um, you know, there’s additional discomfort with it, in, in the groin. There is also a period of time after the procedure where, from what I understand, they, they have to put weights….they put weight on the groin, and you have to lay pretty still for like 6 or 8 hours, where with the procedure in the wrist, you don’t have any of that. You have a small bandage and otherwise, I was able to get up and very mobile.
BRODERICK: About 3-4% of the times, it is only used in the United States. Well up at Good Samaritan Hospital now, I do personally about 85-90% of my procedures through the wrist, and overall, we’re doing them up to 30% of the time now at Good Samaritan Hospital.
At this point, there are no limitations on age or gender, for example, to not do the procedure through the wrist. Sometimes you can’t have it done through that procedure. Sometimes the arteries in the wrist aren’t the right size or the blood flow to the hand to the wrist may be compromised, and that is tested before the procedure is started by a simple test by the staff to look at that. So sometimes people can’t have it; sometimes people have very tortuous arteries up in their chest that we have to go through to get down to the heart, and we just can’t make the turns. So sometimes people get the wrist started and you find you can’t finish it, and you have to go to the groin. Rarely there are procedures that require certain equipment that can only go through the groin, but that is very rare. And a lot of it is physician experience – it takes awhile to be trained in the procedure, to be comfortable with it, just like in any new technique, and so a lot of physicians are starting to be trained in it, and it just takes awhile to learn. And that’s one of the holdbacks, as well.
Heart catheterization in general are done with patients awake, so they are not put to sleep. And what that does, however, is they are given mild sedation, medicine by the vein, to relax them and make them sometimes a little sleepy or calm. And that is pretty much the extent of anesthesia that is used. Patients inordinantly find that it’s a lot easier, less discomfort, much calmer procedure than going through the groin.
Patient: Just this past November, I was experiencing some difficulty, and Dr. Broderick said that he would have to do a heart cath and wanted to see what was going on. So, he had admitted me to the cardiac unit, which is fabulous, and he did a heart cath using my right arm instead of the groin, and I healed beautifully. There’s hardly a scar there at all. I didn’t experience any pain or discomfort at all.
BRODERICK: Once you’re done with the procedure and the catheter is removed, a small compression device that wraps around your wrist that basically looks like a big wristwatch that’s squishing the area where the tube was, that pushes the artery so it doesn’t bleed, and that stays on the wrist for 1-2 hours. And then it’s removed by the nurse on the floor, and it’s healed up. And the nice thing, the hole is so small and there is basically it compresses against the wrist bones, and there is a marked less bleeding complications with that compared to laying for 6-8 hours after the femoral procedure and having devices either pushing on the groin or someone pushing on the groin to hold the bleeding back. And so, patients can move around more, uh, get around quicker, ambulate faster and they feel much better in fact.
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Content Updated: November 7, 2014