LISA HANCHEY

When a patient has heart problems, diagnosing the cause can be a long, uncomfortable process. Typically, a coronary angiogram involves placing catheters into the femoral artery, directing them into the blood vessels supplying the heart, and injecting contrast dye to visualize the vessels. When the groin is used for arterial access, patients might be required to lie down for six hours to complete the procedure. Now, some forward-thinking physicians at Louisiana State University's University Medical Center (UMC) in Lafayette are performing angiograms via the radial artery, cutting procedure time from hours to less than 90 minutes.

Cardiologist Mark Stellingworth, an LSU Tiger "through and through" who has been a member of LSU cardiology at UMC, trained at LSU for both internal medicine and cardiology, treated patients during Hurricane Katrina at University Hospital in New Orleans, is currently teaching the next generation of fellows the radial access procedure. Although physicians have known about the wrist catheter process since the 1980s, only a handful in Louisiana are using this procedure for diagnosing cardiovascular conditions. To Stellingworth's knowledge, UMC is the only state institution that uses the radial access technique on a regular basis. "Nationally, radial procedures perhaps account for about one and a half percent of all procedures done by cardiologists," he said.

Most cardiologists perform the majority of heart procedures like percutaneous intervention through the groin. Using femoral access has its drawbacks, as the vessel is large and located deep within the body. During the test, patients have to lie down on their backs for as long as six hours. With the radial access technique, patients are usually done within 10 minutes. "One of the great advantages of the radial procedure is that after 10 minutes, the patients basically can sit up, and have a wristband placed on their arm that closes off the blood vessel," Stellingworth explained. "They have a greater amount of freedom of movement than they had previously with the femoral technique.

Before administering the radial technique, a cardiologist performs the Allen's test, occluding the radial and ulnar vessels of the patient to check circulation. If re-perfusion takes less than five seconds, then the patient is good to go. Prior to the procedure, the patient usually receives some sedation. Not only does it relax the patient but it helps keep the radial artery open. After applying topical Lidocaine to numb the wrist, the physician inserts a micropuncture needle, then puts in a guidewire over it, targeting the brachial artery under fluoroscopy. Next comes the sheath, through which the doctor places the catheters. The cardiologist provides a "chemical cocktail" -— a combination of three medications to keep the vessel open during the procedure. Angiograms normally require at least two catheters to track the right-sided and left-sided vessels to the heart. However, UMC uses the Terumo Optitorque catheter for the procedure, which uses a single catheter to evaluate both sides. "LSU-UMC cardiology was the first institution in the U.S. to use the Terumo Optitorque catheter," Stellingworth said proudly. "It's pretty helpful, and it also cuts down on the overall time of the procedure."

Once finished, the doctor removes the catheter and places a band on the radial artery to compress the blood vessel. Within about an hour and a half, the patient can go home. "It's been really great," Stellingworth said. "I've been really happy with the outcomes, and I think most of the patients have, too."

The wrist approach is particularly helpful for patients who are obese. Many times, these individuals have concomitant back pain, making it difficult to lie on their backs for hours on end. "However, when we do a radial procedure, we find that not only is it associated with greater patient satisfaction, but we feel that it's also associated with a decreased time of procedure," Stellingworth observed. The radial approach is also preferable in patients with peripheral vascular disease in their lower extremities, where doctors might have difficulty finding a femoral pulse. "Where they have significant blockages in the lower extremities, we might want to go in through the arm," he added. "It makes things easier."

Another reason the radial artery is a particularly good approach for diagnostic catheterization is that it preserves the groin for further interventions, if necessary. While some medical institutions are using the radial intervention technique for procedures such as stenting, the applications are limited. However, comparing radial to femoral interventions, a significant finding is that the groin approach is associated with increased bleeding complications, which can lead to increased mortality.

Currently, LSU's cardiology section is seeking approval for a radial access clinical trial from the institutions Internal Review Board. The trial will track whether patient satisfaction is higher with radial procedures or femoral procedures. Another consideration is fellow training time. Finally, the trial will compare complication rates associated with femoral versus radial access.

"I am excited about the technique," Stellingworth said. "I really do believe that it is going to be the future in medicine."