Memorial doctors perform angiogram from wrist

Procedure used half the time elsewhere, but is rare in United States

[caption id="attachment_30550" align="alignright" width="301" caption="Interventional cardiologist Sanjay Dhar, right, monitors a cardiac catheterization done through the radial artery instead of the femoral artery."][/caption]

SANTA ROSA – Cardiologists at Santa Rosa Memorial Hospital recently performed what they describe as a far less invasive procedure to examine the heart and arteries, making it the first hospital in Sonoma County to perform a procedure that could become the norm.

The procedure, performed in late February on a 73-year-old woman from Sebastopol, was a coronary angiogram in which doctors threaded a catheter through a patient’s radial artery via the wrist to the heart – rather than the traditional method of going through the femoral artery, which is accessed through the groin.

Coronary angiograms are used to either examine blood vessels and blockages in the coronary artery or to intervene in the event of a blockage.

The new procedure vastly improves recovery time for patients while reducing certain risks. It also has the potential to yield big savings on health care costs because it can significantly reduce a patients’ stay in the hospital, among other benefits, according to Sanjay Dhar, the interventional cardiologist who led the team that performed the procedure.

Covered by Medicare and insurance, the procedure could eventually become mandated by insurers, unless there is clinical reason not to use the method, such as for patients who need open-heart surgery, Dr. Dhar said.

“If there is a significant increase in physicians doing it, [insurers] are going to ask why [physicians] didn’t do it,” Dr. Dhar said. “There are valid reasons, but I see that on the horizon with the health care system trying to cut costs.”

Technological advances in medical devices have permitted physicians to revisit the method, which isn’t new but is still rare in the U.S., Dr. Dhar said.

Out of 1.2 million cardiac catheterizations performed annually in the U.S., 1 percent are done through the radial artery. But in Canada, Europe and Japan, about 50 percent of catheterizations are done using the same procedure, according to the Journal of the American College of Cardiology.

“The new catheters are smaller and easier to use,” Dr. Dhar said, noting that Santa Rosa-based Medtronic CardioVascular is one of the companies making such catheters.

Dr. Dhar said he expected the procedure to eventually become commonplace.

“I expect it to become wide-spread very soon and to be a viable option,” he said of the method. “Recovery time is phenomenally decreased.”

By entering through a tiny incision in the wrist, physicians can have far more control over a litany of potential complications that can arise with the traditional procedure, said cardiologist Stephen Halpern, who practices with Dr. Dhar. Chief among such complications is bleeding and clotting, which is less likely to occur when going through the wrist, he said.

“The access of being closer to the skin and controlling the bleeding, both are major advantages,” he said.

More beds will be freed up for the limited number of patients who would need to stay overnight after the procedure, and most patients will be discharged on the same day, Dr. Dhar said – all issues that could contribute to reduced costs.

And patients have greater mobility after the radial procedure versus the traditional femoral procedure – a patient typically needs to lie flat for up to four hours after the traditional approach, so that pressure can be applied to the incision to prevent blood loss. But the radial artery procedure can allow for a patient to recover in a sitting or reclining position and will likely permit them the ability to walk much sooner.

The procedure can be performed on both an inpatient and outpatient basis, Dr. Dhar said.

The procedure may not be for every patient, Dr. Halpern said, but a good majority of coronary angiograms could be done through the radial artery.

While the radial catheterization has gained wide acceptance in Europe and Asia, fewer than 5 percent of cardiologists in the U.S. are practicing it, according to Dr. Dhar. He said peers of his at major research hospitals, like Stanford and the Mayo Clinic, were practicing the procedure, so he trained for it at U.C., Davis and brought the idea back to Memorial, which in turn trained its staff and obtained the new catheters.

Meanwhile, on the same day of performing the 35-minute angiogram procedure, the level II trauma center was one of 50 hospitals in the U.S. – and the only one in Northern California – to take part in a study that tests a new device that could detect heart attacks, known as AngelMed.

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