Better Stenting

January 31, 2009
Safer stenting: arm entry optimal.

Safer stenting: arm entry optimal. MedicalRF.com / Corbis

When it comes to stenting—using metal tubes to prop open blocked arteries—physicians often choose to gain entry to the circulatory system through an opening in the leg instead of the arm, even though the latter option appears to be safer, with fewer side effects, say researchers at Duke Clinical Research Institute.

"Bleeding complications are reduced by 70 percent when interventional cardiologists go in through a radial artery in the wrist," says Sunil Rao, assistant professor of cardiology and the lead author of the study. "But our research shows that only a tiny fraction of stenting procedures are done this way. The study suggests that maybe it's time to change the way we practice."

Rao's team reviewed data from 593,094 cases of percutaneous coronary intervention (PCI) in 606 hospitals across the U.S. included in the National Cardiovascular Data Registry from 2004 to 2007. They tracked the incidence of radial PCI (r-PCI) versus leg or femoral PCI (f-PCI) during that period and calculated which patients were more likely to get which option.

They found that the frequency with which r-PCI was chosen had increased over the four-year period, but still made up only 1.3 percent of the total number of procedures. They also found that 40 percent of r-PCI was performed in only seven centers. Academic medical centers were more likely to be sites of higher r-PCI use than centers not affiliated with a college or university.

"The findings are somewhat surprising, given that numerous studies have shown that r-PCI is similarly successful to f-PCI, and that r-PCI can significantly lower risk of bleeding, especially among women, patients younger than seventy-five, and people undergoing PCI for acute coronary syndrome," says Rao.

The study appears in the Journal of the American College of Cardiology: Cardiovascular Intervention.