WASHINGTON — The best path to a clogged heart may be through the wrist.
About a million artery-clearing angioplasties are performed in the United States each year, and the usual route is to thread a tube to the heart through an artery in the groin.
Now a major study shows going through the wrist instead can significantly lower the risk of bleeding — without the discomfort of lying flat for hours while the incision site seals up. Just one in 100 angioplasties is currently done via the wrist, and the approach isn't for everyone.
"In experienced hands, it can be done more," said Dr. Sidney Smith, heart disease chief at the University of North Carolina at Chapel Hill and a past president of the American Heart Association, who wasn't part of the study. "This approach, when done by experienced operators, has advantages."
Cardiologists have preferred working through the femoral artery in the groin because it is a larger blood vessel than the wrist's radial artery, easier to tug catheters through. When the procedure's over, heavy pressure — often a sandbag — is applied for several hours until the puncture site quits bleeding and essentially seals itself. But heavy bleeding and related complications are a risk, happening in anywhere from 2 percent to sometimes as many as 10 percent of patients.
Catheters have gradually gotten smaller and more flexible, and previous small studies had suggested the wrist approach could be safer because that puncture site can be bandaged. In an earlier study, the wrist method even trimmed hospital costs because patients were discharged sooner.
So Duke University researchers turned to a national registry — analyzing more than half a million angioplasties performed at 600 U.S. hospitals from 2004 to 2007 — to see how often wrist angioplasties are done, and the results.
Just 1.3 percent of the angioplasties were done through the wrist. Both methods were equally effective at clearing heart arteries, Dr. Sunil Rao, lead researcher, reported in the Journal of the American College of Cardiology: Cardiovascular Interventions. All the angioplasties studied were first-time, non-emergency cases.
The wrist method cut the bleeding risk by nearly 60 percent: Nearly 2 percent of patients treated the usual way bled, compared with slightly fewer than 1 percent of those treated via the wrist.
The method may be gaining steam: In early 2007, the researchers measured a sudden jump, as the wrist method accounted for about 3.5 percent of angioplasties performed then.