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This rare achievement puts Paras Hospitals, Gurgaon, among the very few institutions that can boast of such a capacity. Trans-radial approach of primary angioplasty through the wrist is relatively safer and more cost effective than the traditional method of approaching the heart through the femoral artery in the groin.
Dr Tapan Ghose, Director & HOD Interventional Cardiology at Paras Hospitals, Gurgaon says that his team has adopted the revolutionary approach as it cuts chances of complications and saves more lives.
Angiography is a minimally invasive procedure conducted to diagnose the closed arteries. Angioplasty is the procedure to unclog blocked or narrowed arteries in a person’s heart. Small tubes are inserted through the wrist to the heart arteries. After dilatation with tiny balloons, stents are inserted through arteries into the body to open up the obstructed artery, which resume the blood flow. Wrist approach angioplasty, also called the trans-radial approach allows a cardiologist access to a patient's heart through the artery in the wrist unlike the more traditional groin (femoral) approach which requires a catheter to be inserted into the heart via the artery (femoral) in a patient's groin.
“Wrist approach angioplasty has less bleeding, this makes it a better emergency procedure. If a person has had a heart attack and needs immediate emergency intervention to unclog his arteries, this approach is much better than the traditional approach. It saves more lives too.
For patients it is more comfortable and lets them get on their feet rather quickly. It reduces chances of access site bleeding or hematoma formation. Our analysis (Direct Pilot Study) is that it has lower complication rates than the traditional groin incision approach,” says Dr Ghose.
Dr Ghose has been performing angioplasties through the trans radial approach for several years. Now, his entire team of cardiologists at the hospital has equipped itself in this capability.
90% of our PTCA’s (Percutaneous transluminal coronary angioplasty) are done through the tranradial route. The same requires patient selection and aspects to be considered, says Dr Tapan Ghose. We ensure that all detailed protocols of patient selection and procedure are followed in our cath lab.
In Europe, Canada, Japan and China, a large number of cardiologists today are preferring PTCA through radial artery access. However, in other countries, including India, angioplasty through wrist is still not very common. In India, approximately 30% per cent of the total angioplasty procedures are done through the wrist.
Lack of trained professionals in this approach is perhaps one of the reasons.
“There are relatively lesser number of interventional cardiologists trained in the radial approach. It is a difficult approach which needs skill and training. Majority of the training institutes do not have a structured training programme in this approach of angioplasty, which is the need of the hour,” says Dr Ghose.
With the hospital adopting the trans-radial approach, the cardiologists will now be able to offer better chances of survival and quicker recovery to patients.
The European Society of Cardiology has also endorsed the use of trans-radial approach for angioplasty in its recent guidelines of primary angioplasty.
“The society endorses this approach in the institutions where skilled interventional cardiologists in tranradial route are available,” said Dr Ghose.
Recently researchers at the University of Pennsylvania, the University of Washington Medical Center, and the University of Pittsburgh School of Medicine conducted a cost benefit analysis to conclude that the radial artery approach resulted in less vascular complications and significant cost-savings as against the femoral artery catheter access. In acute heart attack angioplasty through the wrist saves more lives as compared to the groin route.
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