Same-Day Coronary Stenting via Wrist

The wrist may be a safer port of entry than the groin for coronary-artery stenting and would allow same-day discharge following angioplasty, according to a new study presented at the annual meeting of the American Heart Association in Dallas (TX, USA) in November 2005.

Doctors used transradial percutaneous coronary intervention (PCI) combined with a single bolus administration of RepPro (abciximab) in the study, which allowed patients to be discharged without an overnight stay, according to Olivier Bertrand, M.D., of Laval Hospital (Quebec City, Canada). The study compared 504 patients randomized to same-day discharge with 501 patients randomized to overnight stay.

The results showed that 88% of the patients randomized to same-day procedures were discharged on the same day. Also in the same-day group, 13.9% of patients met the primary endpoint vs 11.8% in the overnight group. Six months later, the rate of death, heart attack, or revascularization was 5.7% in the same-day group and 5.4% in the overnight group. Transradial stenting is also less expensive than groin stenting since it reduces hospital costs and requires only a single bolus of ReoPro.

Although the transradial approach is popular in Canada, few U.S. centers have made the change from the femoral artery to the radial artery. "The radial artery is trickier mainly because of concerns about circulation problems in the hand,” noted Dr. Timothy Gardner, M.D., program chairman of the American Heart Association. "Diabetic patients, for instance, could be problematic.” On the positive side, Dr. Gardner agreed that it is easier to control bleeding with a transradial approach, since it is easy to immobilize the arm and get patients up and walking.