Arm Access for Angioplasty

This is good news because aforearm entry will likely be handled better by the patient.  Sealing the artery after the operation is aclumsy procedure from the patient’s point of view if it uses the femoralartery.  The arm option will allow fulluse of the other hand to assist.  Thedistance is also quite a bit shorter.

I anticipate that artery entrywill become routine for additional procedures in the next few years as we haveplenty of trained specialists.

I also suspect that the proceduremay be conducted with the patient sitting up. That would likely be beneficial.

Alternate route to blocked arteries safe and effective for angioplasty

April 4, 2011

http://www.physorg.com/news/2011-04-alternate-route-blocked-arteries-safe.html

A landmark international study coordinated by the Population HealthResearch Institute of McMaster University and Hamilton Health Sciences has found accessingblocked arteries throughthe forearm compared to groin led to fewer vascular complications and similarsuccess rates for angioplasty.

The large, multi-centre randomized trial – the first of its kind tocompare radial access and femoral access – found that both entry points forangioplasty resulted in similar outcomes, including rates of death, heartattack, stroke or non-bypass-related major bleeding. As well, radial access –or entry through the forearm – led to better outcomes in hospitals thatconducted a large number of these procedures and in patients suffering heartattacks in which a coronary artery was completely blocked by a blood clot (acondition known as STEMI, or ST-segment elevation myocardial infarction).

Results of the RIVAL (RadIal Vs. femorAL access for coronaryangiography or intervention) trial are being presented by Dr. Sanjit Jolly, aninterventional cardiologist and assistant professor of medicine in the Michael G. DeGroote Schoolof Medicine, at the annual American College of Cardiologymeeting.

The study is also being published simultaneously in The Lancet.

Estimates suggest that more than 10 million coronary angiograms areperformed each year worldwide, three million of them in the United States.Entry through the groin, or femoral arterial access, has been the dominantroute for coronary angiography and intervention for more than 20 years. Itstill accounts for approximately 95 per cent of procedures in the United Statesand 80 per cent of procedures worldwide.

The radial artery, accessed through the wrist, is a superficial andeasily compressible site for arterial puncture, and used to avoid femoralbleeding complications. However, there have been concerns that radial accesscould be associated with reduced angioplasty success rates.

The RIVAL trial, conducted by researchers from 36 countries, wasdesigned to help determine the optimal access site for invasive coronaryprocedures, such as angioplasty. The study involved 7,021 patients undergoingcoronary angiography, with possible angioplasty, who had unstable angina or aheart attack. Patients were randomized to either radial or femoral access fortheir coronary angiography/intervention.

"Our data suggest that radial compared to femoral access reduceslocal vascular access site complications with similar angioplasty successrates," said Dr. Jolly, the principal investigator of the RIVAL TrialGroup. "However, greater expertise and procedural volume with radialaccess may improve the results of the radial approach."

The researchers concluded both access sites are safe and effective forconducting invasive coronary procedures in patients with acute coronarysyndrome, a spectrum of cardiac conditions ranging from unstable angina toheart attack.

"This is the first multi-centre international trial to addressthis important question," said Dr. Shamir Mehta, a RIVAL co-investigator,interventional cardiologist, and associate professor of medicine in the Michael G. DeGroote School of Medicine.

"Given the results of previous small trials, we were surprised tonot find a difference between the two strategies for the primary outcome. Thismeans either a radial or femoral approach can be used safely andeffectively."

Provided by McMaster University