‘Radial Artery Approach should not be glamourised’

EHM News Bureau - Mumbai

The take home message of a workshop on Radial Artery Approach (RAA) in performing coronary angioplasties conducted at Dr LH Hiranandani hospital recently was that RAA should not be glamourised as a superior technique to the conventional groin approach.

Said Dr Ganesh Kumar, chief interventional cardiologist, Hiranadani Hospital, who led the workshop, "RAA in performing coronary angioplasty is among one of the changing trends in the field of percutaneous coronary interventions. It is relevant in India, barring a few intricacies, as it is quite convenient to patients, the recovery period being much faster. RAA should be rightly used in selected cases, keeping the patients interest as a top priority, and should not be glamourised to patients and cardiologists." Other experts on the panel were Prof (Dr) Funck Francois, a leading interventional cardiologist from France and an expert in RAA.

The workshop was aimed at highlighting the advantages and difficulties of this very interesting technique. Speaking on the intricacies of the radial artery approach, Dr Kumar said, "The radial approach requires selected cases in Indian scenario because of the ethnic diversity of the country. This is because of the fact that the radial artery (wrist artery) is much smaller in size compared to the conventional femoral artery (artery of the groin). The size of the artery is based on the height, weight and built up of the person." Hence, not all cases are suitable for the radial approach.

The smaller radial arteries can go into spasm, which makes it difficult for the catheter to manoeuvre inside the artery. "Upgradation of the catheter into a large size becomes necessary in certain complex cases during the radial approach procedure, which is time consuming," he added.

One of the cases in the workshop required bifurcation stenting (implantation of two stents in the main and side branch simultaneously) for which an upgradation to a larger size catheter and lot of catheter manipulation was required. "We took almost two hours to complete this case, which by a femoral approach could have taken less that an hour. Hence one should still think twice before attempting a complex coronary intervention by this approach," said Dr Kumar. For another patient from the workshop weighing only 46 kgs having thin with aesthetic built, both Dr Funck and Ganesh Kumar mutually agreed that a femoral approach would be more appropriate in view of the small sized radial artery.