Percutaneous Coronary Intervention (PCI): Lifesaving Treatment Right Here.

Because the longer it takes for treatment in a cardiac event, the more heart muscle is lost, we can save time and heart muscle with this interventional treatment.  In fact, cutting treatment time under 90 minutes, according to the American College of Cardiology, saves heart muscle, prevents long term, irreversible damage, and delivers better overall outcomes.

PCI is a treatment procedure that unblocks narrowed coronary arteries without performing surgery. During this procedure, your cardiologist determines the best treatment for your condition. Treatment will vary from patient to patient.

Balloon catheter angioplasty: During this procedure, the cardiologist inserts a cardiac catheter with a small balloon around it into the coronary artery. The cardiologist then places the balloon in the narrowed area of the artery and expands it with liquid. This pushes the plaque (blockage) to the sides of the artery where it remains. This technique reduces the narrowing in the artery and restores the normal size of the artery. The cardiologist removes the balloon catheter at the end of the procedure.

Stent: The cardiologist places a small, hollow metal (mesh) tube called a "stent" in the artery to keep it open following a balloon angioplasty. The stent prevents constriction or closing of the artery during and after the procedure. Drug-eluting stents are now used. These stents are coated with medication that helps prevent narrowing of the artery.

Transradial Access: Getting to the Heart of the Matter

More than one million cardiac catheterizations are performed in the United States each year.  Some are diagnostic, and others are interventional (angioplasty).  Both procedures start the same, with a need to gain access to a patient’s arteries in order to determine if there is a blockage that may be restricting the flow of blood and where that blockage may be. 

In the majority of procedures in the United States, access is made through the femoral artery located in the groin.  Outside the United States, the preferred method in many countries is to go through the radial artery in the wrist (transradial access).  This method is beginning to increase in the U.S., as well.

We believe that transradial access offers many benefits to our patients. To learn more about the transradial access approach, please read the information provided below, including questions you may want to ask your interventional physician on your next visit.

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What is transradial access?
Transradial access uses the radial artery, found in the wrist, as an entry point for diagnostic and interventional cardiac procedures.

Is transradial access something new?
No. Physicians have been performing tansradial procedures for more than 20 years.

How does it compare to transfemoral access?
Both techniques provide viable access options to the physician performing diagnostic and interventional procedures involving the heart.  Once access is made, the procedures that follow are virtually the same.  Each technique has perceived benefits and some limitations. 

When a transradial access procedure is selected, patients generally have less acknowledged pain and experience significantly faster ambulation (ability to walk around after the procedure) versus patients treated using femoral access.  Patients undergoing procedures through the groin (transfemoral) generally must lie flat for four-to-six hours post procedure, while a recovery nurse or technician holds pressure on the groin in order to prevent bleeding at the access point. Actual procedure time and procedure costs are considered comparable.

Is one method better than the other?
Femoral access is the most widely used method in the United States.  The primary reason for this is physician habit.  Most physicians in the United States who perform diagnostic and interventional cardiac procedures today were trained on this method and lack training or experience with transradial access.  As a result, femoral access is considered their default access strategy.

It is important to note that there are increased patient risks and discomfort associated with femoral access, including:

• The inability for an operator to gain arterial access through the femoral artery, especially in obese patients or patients with a history of peripheral vascular disease.
• An increased risk of bleeding complications, especially at the puncture site.  Sometimes this complication is quickly evident. Other times, the bleeding is less obvious (internal).  There is also a documented higher risk of bleeding complications among women than among men. 
• The potential need for transfusions as a result of the bleeding complications.
• An increased risk of nerve damage.
• The patient’s need to lie flat for four-to-six hours after the procedure.
• Greater post-procedure pain.
• Significantly longer recovery time post procedure.

The radial artery, which is found in the wrist, provides an alternative access point.  Successful use of the radial artery (transradial access) offers some unique advantages, but does require the doctor to learn and become proficient with a different access skill set.  Additionally, the physician needs to consider the potential for vessel spasm that sometimes occurs.  Benefits include:

• No need to worry about (interrupt) patients who may have received blood thinners prior to transradial access.
• Virtually no incidence of bleeding complications.
• Greater access success for obese patients and patients with a history of peripheral vascular disease.
• Quicker mobility for the patient after the procedure. A patient is able to be mobile almost immediately after the procedure completes.
• Quicker discharge from the hospital, enabling more procedures to be performed on an outpatient basis.

Can transradial access be utilized 100 percent of the time on all patients?
No.  There are some situations where transradial access is not possible and may require the operator to use either a femoral or brachial (elbow) approach.

How do you determine if I am a good candidate for transradial access?
Most patients can be treated transradially.  Your doctor will determine if you are a good candidate based on your pulse and type of procedure.