If you are experiencing chest pain, your doctor may recommend a cardiac catheterization (also known as a coronary angiogram) to get images of your heart and learn the cause. Cardiac catheterizations are one of the most common diagnostic procedures for heart patients and are also commonly used to treat certain cardiac conditions like blocked or narrowed arteries that result in a heart attack. A newer method of performing the procedure is gaining popularity among cardiologists. It makes a catheterization procedure more comfortable for the patient and provides a quicker return to normal activities.
To do a cardiac catheterization, a cardiologist inserts a catheter (a long, thin tube) into an artery in the groin or the wrist and threads the catheter to the aorta (the main artery of the body) and then to the heart arteries. Using contrast dye and X-ray technology, the cardiologist can visualize the heart’s blood supply and determine if there are blockages that might explain chest pain or the cause of a heart attack. Once identified, heart artery blockages can then be fixed by placing a small metal mesh tube, called a stent, inside the artery.
For many years, cardiologists only performed cardiac catheterizations by using the femoral artery in the groin. This is still the most widely used catheterization technique in the United States. However, results of several large, randomized clinical trials in recent years have shown advantages in performing the procedure through the radial artery in the wrist. Within the Froedtert & MCW health network, more than half of all cardiac catheterizations are done using a transradial approach (through the radial artery).
“Radial catheterizations are easier on the patient,” said Peter Mason, MD, MPH, an interventional cardiologist and director of the Froedtert & MCW Cardiac Catheterization Laboratory. “Patients can leave shortly after the procedure and return to normal activities such as walking and driving. With the femoral approach, patients have to stay in the hospital on bed rest for two to four hours after the procedure to prevent bleeding and have greater limitations upon discharge.
A number of clinical trials have compared risks in radial and femoral catheterization approaches. The transradial approach was associated with lower risks of bleeding and vascular complications. This benefit is particularly apparent in high-risk patients, such as the elderly, patients who are overweight and obese, and patients experiencing a heart attack. In fact, in patients experiencing a heart attack, there may be a survival benefit of the transradial approach compared to femoral access. The femoral artery is larger than the radial artery and its location makes bleeding comparatively more likely and more difficult to manage.
“The radial artery is a smaller vessel, immediately adjacent to the skin,” Dr. Mason said. “If bleeding occurs, it can be easily managed with simple pressure.”
One large trial randomized heart attack patients into two categories — femoral catheterization or radial catheterization — and found the transradial approach reduced patients’ risk of bleeding by half, virtually eliminating bleeding.
“Heart procedures have become very common and are, for the most part, very safe,” Dr. Mason said. “This is an option to even further increase safety and greatly improve patient comfort and mobility.”
The cardiologist can test blood circulation in the hand before deciding to use the radial artery. The majority of people who need to undergo a cardiac catheterization are candidates for access through the radial artery. Dr. Mason said the decision usually comes down to physician preference. Within the Froedtert & MCW health network, physicians advocate for a “radial first” approach.
One of the reasons the transradial approach is not more widely used is that it requires the physician to learn a new technique.
“In Canada, parts of Europe and Asia, the vast majority of procedures are done through the wrist,” Dr. Mason said. “Radial catheterization is an important procedural development that is late to our country. If I can help reduce the risks and speed up a patient’s recovery, I will always choose that option.”
