Cardiac catheterization through the wrist

The methods for widening coronary arteries using a balloon were developed in the late ’70s, and the deployment of stents to coronary arteries became standard towards the end of the ’90s. In all these, catheterization was performed via the femoral artery in the groin, which allows convenient access to the coronary arteries. After local anesthesia, a special sheath is inserted in the artery, through which catheters are passed up to the coronary arteries. The contrast medium is injected through the catheter, and the entire process is imaged with x-ray apparatus. The physician is thus able to see the coronary arteries.

Diagnostic catheterization, in which the catheter is inserted via the radial artery in the wrist, was attempted for the first time in France in 1989. In 1995, catheterizations began to be performed through the wrist, in which a balloon is introduced into the heart, and later, catheterization for deploying a stent through the wrist was also developed.

An increasingly large number of interventional cardiologists are adopting the novel approach for catheterization through the wrist, called the “radical approach”. This approach is much more comfortable for the patient. The risks associated with the “radial approach” are significantly smaller for catheterization via the groin, which has been practiced for the past three decades.

Cardiac catheterization through the wrist

The difference between the approaches is seen in the type of sheath used, and sometimes in the types of catheters. The imaging, balloons, and stents deployed to open the blood vessels are identical in both types of catheterization. Catheterization via the radial artery significantly reduces the complication rate in comparison with catheterization via the groin. It does not involve hemorrhages and damage to blood vessels in the groin. An additional advantage is a patient comfort. If the catheterization is performed via the groin, it is necessary to be careful to apply massive local pressure in the area where the artery was punctured and to remain to lie down for a prolonged time with minimal movement. The patient usually remains in the hospital for observation until the next day. Failure to be careful with these rules after catheterization via the groin could increase the complication rate. With catheterization through the wrist, the patient may get out of bed, sit and sometimes also walk immediately after the catheterization. There is no need to remain to lie down for a prolonged period or for local pressure. The patient can, therefore, in many instances be discharged to his home on the same day that the catheterization is performed.

The decision regarding the catheterization approach depends first of all on the physician. Most physicians still catheterize via the groin, as this approach is technically more convenient. Catheterization through the wrist requires special skill, training, and above all – learning and adapting to the technique. In order to become skilled with this method, the physician needs to gain experience with several hundred treatments. In recent years, the medical establishment has begun to recognize the advantages of catheterization through the wrist, and the number of catheterizations performed by this method is steadily increasing internationally and in Israel. In the USA, some 10% of catheterizations are performed through the wrist. In France, over half the catheterizations are performed by this method. In Israel, there are no overall statistics, but the tendency to switch to catheterization via the wrist has recently been increasing. Today, catheterization through the wrist can be offered to most patients. Even though special skill is needed, it does give the best of all worlds: patients benefit from comfort, significant reduction in complications and early discharge from hospital; and the health care system benefits from shorter hospital stays and reduced costs.

At Herzliya Medical Center, cardiac catheterization through the wrist or through the groin is performed routinely.

This article was written by Dr. Michael Yonash. A senior cardiologist at the Invasive Cardiology Unit at Kaplan Hospital. Consultant and interventional cardiologist at Herzliya Medical Center.

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