Angioplasty is an operation to repair a
damaged blood vessel or unblock a
coronary artery.

Using the wrist means doctors are
getting access to the heart through the
radial artery in the arm rather than the
femoral artery, which delivers blood to
the lower extremities.

While technically more challenging for
doctors, the radial technique is
associated with fewer bleeding
complications and better long-term
results for patients in a growing
number of studies.

In 2011 only about 8% of cardiac
catheterizations performed in the U.S.
use the radial approach. That's up
from less than 2% about four years

The rate is well behind several
European countries such as Norway
and France, and Japan, where rates
typically exceed 50% and in some
cases are above 70%.

The radial procedure isn't perfect.
The radial artery is smaller than its
femoral counterpart. Especially in older
patients, it can develop twists and
loops that make it difficult for doctors
to get the catheter to the heart. The
procedure may take longer than the
femoral technique and thus increase
radiation exposure to both patient and
physician. But with practice, doctors
can become proficient and routinely
overcome such challenges.

A trial called Rival has been has been
underway since 2006 comparing the
two methods and it has reported
results in April 2011. It enrolled more
than 7,000 patients at centers around
the world to compare the two
strategies on rates of death, heart
attacks and major bleeding within 30
days of the procedure. It was led by
Sanjit Jolly of McMasters University in

The result is as follows: While both
methods are equally effective in
clearing heart arteries, going through
the wrist results in fewer complications.
The wrist approach cuts the bleeding
risk by nearly 60 percent. Bleeding
complications with this approach are
less common in high-risk individuals
such as the elderly and those with
acute coronary syndromes.
The wrist approach lowers hospital
costs as the puncture site can be
bandaged and patients are discharged
quicker. Moreover, it overcomes the
discomfort of lying flat for hours in
order for the incision site to seal up.

A Canadian study adds compelling
support for current recommendations
that people who first get clot-dissolving
treatment for heart attacks should
have artery-opening angioplasty as
soon as possible afterward.
The study shows that angioplasty
should be done within six hours. The
trouble is that many medical centers
are not equipped to do the procedure
on an emergency basis

Peripheral angioplasty to save legs,
feet from amputation;

Balloon sinuplasty to unplug sinuses
by Acclarent;