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Nov 06, 2013

First-Ever Trial Comparing Angioplasty Strategies

Study finds that accessing arteries through the wrist for angioplasty is just as safe and effective in women as traditional access point in the leg.

Angioplasty is more safe and effective than ever before, thanks to cutting-edge research that’s made this minimally invasive procedure possible. And according to research presented October 29 at a medical conference in San Francisco, using a novel access site for angioplasty could reduce risk for complications by as much as 60% in female patients.

This was the first-ever trial comparing outcomes from angioplasty using two access sites—femoral (the leg) vs. radial (the wrist). During angioplasty, a thin, flexible tube is inserted into the body and threaded through a blood vessel to open up narrow or blocked arteries. In the past, doctors have always inserted this tube through a vessel in the leg (femoral access), but evidence suggests that accessing a vessel through the wrist (radial access) may be just as safe.

Known as the SAFE-PCI trial (Study of Access site for Enhancement of PCI for Women), this study enrolled nearly 1,800 women undergoing angioplasty and assigned them to “new” radial access or the more traditional, femoral access. After following patients for 30 days following their procedure, researchers found no difference in efficacy, complications or risk of death between the two groups. However, they found that radial access reduced risk of bleeding and vascular complications by 60% in a small group of patients. And interestingly, about 6% of women undergoing angioplasty with radial access needed to switch to femoral access in the middle of the procedure due to slight complications.

The radial artery is the smallest artery used for angioplasty, which is why many experts worried that it might not be as safe or effective as traditional access points, especially in women. Women already have smaller arteries than men, and choosing to do the procedure through a small artery could increase risk for complications. But according to results of this randomized trial, which is considered the gold standard for research, results are promising.

Using radial vs. femoral access may be a reasonable option for women undergoing angioplasty, especially for those who prefer it over the more traditional route. This study found that given the choice, 72% of women generally preferred radial access and with additional research, it’s possible that doctors will offer this new approach more readily to women, despite initial concerns.

Questions for You to Consider

  • What is angioplasty?
  • Angioplasty (also called percutaneous coronary intervention) is often recommended for patients diagnosed with diseased arteries of the heart (coronary arteries) or for patients suffering a heart attack. Angioplasty includes a variety of procedures developed to compress fat and cholesterol build-up in the arteries, known as plaque deposits, to help increase the size of narrowed or blocked arteries and improve blood and oxygen flow to the heart.
  • How do femoral and radial access differ when it comes to angioplasty (percutaneous coronary intervention)?

  • The procedures for PCI remain the same, aside from access points for catheterization. However, by utilizing radial access, the patient does not need to lay down for the procedure, which helps decrease discomfort and pain. Also, femoral access can be complicated by excess fat in overweight patients, whereas the wrist remains thin in all patients, making radial access less difficult, particularly in overweight and obese patients.

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