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Best Access for Heart Procedures Is Via the Wrist

Update Date: Jun 11, 2013 01:00 AM EDT

More cardiologists are switching to wrist-based angioplasty, a medical procedure that uses blood vessels in the forearm to remove blockages in heart arteries, according to study in the American Heart Association journal Circulation.

In 2012, transradial PCI accounted for one in six such procedures in the U.S., up from less than one in 50 in 2007, according to Dmitriy Feldman, MD, of Weill Cornell Medical College in New York City, and colleagues.

"We found that transradial primary PCI in the United States is increasing gradually, but still lags behind transradial PCI for other nonacute indications. This likely reflects concerns over metrics related to rapid reperfusion (door-to-balloon time) that may be adversely affected by radial access," study researcher Dmitriy N. Feldman, MD, assistant professor of medicine at Weill Cornell Medical College, New York Presbyterian Hospital, Greenberg Division of Cardiology, and colleagues wrote.

Feldman and his colleagues studied data on nearly 3 million artery-opening procedures and found that bleeding complications occurred in about 3 percent of the radial artery procedures, compared with about 6 percent of the femoral artery procedures.

"Traditionally, femoral access has been taught and used in the United States for PCI, whereas the radial approach is frequently used in Europe," Dr. Feldman said.

Another route to the heart can be accessed via the wrist's radial artery. A study, led by Dr. Dmitriy Feldman of Weill Cornell Medical College, found that more doctors are choosing this path.

Feldman and his colleagues examined data from nearly 3 million procedures conducted at over 1,300 medical centers from 2007 to 2012. They found the number of wrist-based angioplasties jumped 13-fold during the time period.

Overall, transradial PCI accounted for 178,643 procedures from 2007 to 2012, or 6.3 percent of the total. But in the first quarter of 2007, transradial procedures accounted for just 1.2 percent of the total, while in the third quarter of 20121, the proportion had risen to 16.1 percent, the researchers found.

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