It's been said the best way to a man's heart is through his stomach. In cases of cardiac catheterization sometimes the best way to open a clogged artery in the heart is through his arm. Nancy Naeve Brown got to watch a radial access stent procedure in the cath lab at the Avera Heart Hospital.
Interventional Cardiologist Dr. Raymond Allen with North Central Heart and his team at the Avera Heart Hospital are placing a stent in a patient who has coronary artery disease. The man on the table is in his 60's from Southwest Minnesota and had open heart bypass surgery 14 years ago, but one of the grafts has narrowing now. A stent is a mesh-like device that acts as scaffolding for the artery. Dr. Allen gets the stent to the narrowed vessel by threading a long thin tube called a catheter through an artery. In this case, Dr. Allen is using the radial artery in the arm instead of the femoral artery in the leg.
Dr. Allen says, "There is a big debate going on right now on whether there is an advantage (between the two access points). The patients like it because it's a nice easy access point and avoids having to lay flat for a long period of time. It's also allows easy compressibility so we can compress and therefore have fewer bleeding complications relative to the leg particularly as people get bigger or have problems being ambulatory and moving around."
The biggest complaint from patients who have had a stent placed through the artery in the leg is that following the procedure they have to lie flat on their back for 6 hours without moving.
Dr. Allen says, "Most people would be a candidate for radial access. Sometimes in smaller individuals the artery is of such a small caliber that is precludes access. Since it also supplies the hand we need to make sure there is another blood supply to the hand. Most people will have dual supplies so that the owner artery comes down one side of the arm, the radial comes down the other and there is an arcade that connects them in your hand so the loss of either artery is not critical. We check that with the Allen's test, no relation to me, to make sure either artery is capable of supplying the thumb."
From top to bottom Dr. Allen accessed the artery, placed the stent with angioplasty and opened the blocked artery all in 15 minutes. Within a few hours the patient was up walking around. In this instance, the best way to this man's heart was definitely through his wrist.
The patient stayed in the Avera Heart Hospital only one night and then returned home to Minnesota as good as new.