Going in through the wrist rather than the groin is rapidly becoming the route of choice for stenting because a series of studies have shown that doing so exposes patients to a lower risk of bleeding and allows them to get out of bed and moving soon

An aborted operation in La Jolla shows the true strength of an increasingly popular way to open blocked blood vessels.

A Scripps Health cardiac team had planned to use a stent to clear a narrowed section of a patient’s left main coronary artery. But after inserting a long, super-thin wire called a catheter, it determined that the blockage was not serious enough to justify the procedure.

The patient was able to go home shortly after the catheter was removed because his doctors decided to use the radial artery in his arm, rather than the femoral artery in his leg, to access his heart.

Choosing the femoral artery would have meant creating a puncture in his groin — and that would have meant spending three to six hours lying on his back waiting for the wound to close enough before he could stand again. By comparison, using the radial artery required only a needle stick that made a tiny nick.

“The patients love it. They can get right up and walk off the table,” said Dr. Paul Teirstein, the interventional cardiologist who led the team that performed Thursday’s procedure in La Jolla.

Going in through the wrist rather than the groin is rapidly becoming the route of choice for stenting because a series of studies have shown that doing so exposes patients to a lower risk of bleeding and allows them to get out of bed and moving sooner, lowering risk of complications such as blood clots. Shorter hospitals stays also mean lower costs compared to using the femoral artery with its longer recovery times.

Despite these advantages, the radial artery path often goes untaken. Dr. Adhir Shroff, a catheterizatoin specialist at the University of Illinois College of Medicine and a fellow of the Society for Cardiovascular Angiography and Interventions, said only about 30 percent of procedures performed in the United States in 2015 entered through the wrist despite the fact that doing so is considered superior for most patients.

But the interventional cardiology community has recently entered a period of rapid change.

“In 2007, the rate nationwide was only 1 percent, so, given that we’re at more than 30 percent today, it’s easy to see that the radial approach is gaining a lot of traction,” Shroff said.

He added that his practice in Illinois now uses the wrist in more than 90 percent of cases. Scripps Clinic reported that it has passed the 80 percent mark, up from only 10 or 11 percent in 2011.

Radial access for catheterization has moved much more quickly in Europe, China and other parts of Asia. Shroff said he believes those regions’ nationalized medicine systems have embraced the radial artery more quickly because it allows patients to return home more quickly, freeing up often-scarce beds in busy labs for the next patient in line.

“They have fewer cath labs per patient, and they really need rapid turnover. They’ve found that, with radial access, the recovery period was much shorter,” Shroff said.

Why, then, have American doctors been much slower to follow suit?

This, Shroff said, is a complicated question. For one thing, using the femoral artery is safe for patients. While studies do show a lower rate of complications going the wrist route, the likelihood of dying from either method is under 1 percent.

At the same time, doctors are busy and may not see a compelling reason to move away from the femoral artery technique that has served them well in the past.

Teirstein was in that camp. Because it’s larger and doesn’t bend and twist as much as the radial artery, he said he was very skeptical about taking the time to learn the new procedure which initially meant that he would have to spend longer in the cath lab.

Though he said he thought most of his cases were too complicated for radial artery to work, he quickly found otherwise.

“I started with the easy cases and slowly started adding the harder cases. Now we pretty much do everybody from the wrist if we can,” Teirstein said.

There are some patients for whom whom using the radial artery is not feasible. Dialysis patients may not be suitable, and those who have had their radial artery removed to be used as a heart bypass graft also are not candidates. Some very small women might have radial arteries that are too small, though the vast majority, Shroff said, have no problem.

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