Radial angioplasty: Major shift in interventional cardiology

Coronary Artery Disease (CAD) will take epidemic proportion by 2015 and will exceed infectious diseases as the most common cause of death in the country, predict experts.

Angioplasty is a well-established procedure performed to reduce or eliminate blockages in coronary arteries. It restores blood flow to blood-deprived heart tissue. The arteries are accessed through a needle puncture made in the groin (femoral artery) that serves as the principal provider of oxygen-rich blood to the leg. In each leg, it branches off near the knee into smaller arteries that supply blood to the lower leg and foot.

The procedure can take from 30 minutes to several hours, depending on the number of blockages being treated. However, there are certain drawbacks when one uses the femoral route.

Disadvantages of angioplasty by femoral route

• Problems in locating site of insertion in obese patients.
• Procedure complications faced due to length of post-operative compression technique to prevent excessive bleeding.
• Patient mobility is hampered and related complications like back pain.
• Duration of hospital stay increases due to complications, hence expenses increase.
• Region of insertion area, sensitive to post-operative complications like haematamas, nerve end injuries etc.

In contrast is radial angioplasty, which is conducted through the wrist blood vessel, instead of the femoral vessel, which until now was generally used. Radial angioplasty is being considered as the gold standard for evaluation of CAD and gives a perfect idea of the nature and extent of coronary disease and blocks. Radial angioplasty is gaining recognition in India as it is safer and has fewer complications. In this procedure, no hospitalisation is required making it more economical. Sometimes patients prefer radial route due to inhibitions. The technique is also preferred as mobilisation of patients post-procedure is very fast as compared to femoral access. Also, post-operative vascular complications are significantly less, enabling the patient for a speedier and easier recovery.

However, the success of radial angioplasty can be threatened by risk factors such as smoking or high cholesterol levels, which unchecked could lead to further complications. Therefore, people receiving treatment are encouraged to learn and practice a good lifestyle for a healthy heart. Patients are also advised to take their medicine regularly to reduce the likelihood of future blockages. Also, a patient need to monitor his eating habits and should be encouraged to take up exercise programme as per his health and fitness goals.

Also, the patient is in and out of the hospital, the same day and may return to work after few hours, almost certainly the next day. It is as simple as going to the dentist to have a tooth extracted!

The writer is the head of the department and consultant cardiologist at PD Hinduja Hospital , Mumbai.