WILLIAMSPORT Coronary heart disease (CHD) is the number one cause of death for both men and women. Individuals who experience a heart attack or fail a stress test often require a heart catheterization and percutaneous coronary intervention (PCI) angioplasty.
Three Susquehanna Health cardiologists, Dr. Donald Nardone, Dr. Christopher Tobiasz and Dr. Robert Trautwein, now perform a transradial catheterization that is more comfortable for the patient and requires less recovery time.
During the catheterization, a catheter is inserted through an artery in order to visualize the coronary arteries and to determine the extent of blockage and to perform treatment such as angioplasty. Traditionally, the procedure is performed through the femoral artery located in the groin area. The transradial catheterization provides access to the heart through the radial artery in the wrist.
Dr. Donald Nardone
Dr. Nardone has been using the transradial approach since 2010. Before the transradial approach is performed in the cardiac catheterization lab of Susquehanna Health's Heart & Vascular Institute, a patient is screened using the Allen's test to determine whether there is adequate blood flow in the radial and ulner arteries. The access area, located behind the thumb just above the crease of the wrist, is numbed with Novocaine.
Next, an introducer sheath (a hollow plastic tube) is inserted into the radial artery, and the patient is given medication to prevent the artery from going into spasm during the procedure because this inhibits the insertion of the catheter. The catheter is then threaded through the arm and to the heart. At this point, the heart catheterization is performed in the same manner as the femoral approach by injecting X-ray contrast into the coronary arteries. Angioplasty can also be performed using the transradial approach.
As the procedure is completed, a band (referred to as a TR band), is placed over the patient's wrist and filled with air to compress the area without blocking the radial artery. This band helps control bleeding and enables the patient to move around more freely soon after the catheterization. The femoral approach, in contrast, requires a patient lie flat for one to six hours throughout the catheterization and recovery. "Since the patient can ambulate sooner, the stay can be shorter and the patient can be discharged earlier," says Dr. Nardone.
"The advantages of the transradial catheterization are twofold: patient comfort and earlier ambulation," says Dr. Nardone. In addition, the transradial approach increases patient safety because it reduces the chance of more serious and life-threatening bleeding after the procedure. Unlike the femoral approach, there is less area for internal bleeding to go undetected. Typically, when a patient has experienced both the femoral and transradial approaches they request the transradial approach for their next cardiac catheterization, according to Dr. Nardone.
Data indicates that the transradial catheterization is more common in Europe and Asia and steadily becoming more adopted worldwide. The United States, however, has been slower in adopting this approach-but, interest is increasing. According to Dr. Nardone, not long ago fewer than 10 percent of heart catheterizations performed in the U.S. use the transradial approach. "It's kind of unique that in this part of Pennsylvania, there are actually many more doctors performing transradial catheterizations than in other parts of the country," says Dr. Nardone. He attributes slow adoption of the procedure in the U.S. to the higher comfort level cardiologist have with the femoral approach, since that is how most were trained.
"From a personal and professional point of view," says Dr. Nardone, "I'm glad that we offer the transradial approach to patients." Dr. Nardone is board certified in cardiovascular disease and interventional cardiology. He is a fellow of the American College of Cardiology and the Society for Cardiovascular Angiography.
For more information on Susquehanna Health's Heart & Vascular Institute, call 570-321-2800 or visit online at SusquehannaHealth.org.