Wrist best spot for angioplasty in elderly

The wrist is a better access spot than the groin for performing angioplasty in very elderly patients with heart disease, new research shows.

Although both sites provide good results, the wrist is associated with fewer complications.

The goal of angioplasty is to re-open clogged coronary arteries that feed the heart. To do this, a tiny balloon-tipped catheter is threaded into an easily accessed artery and then guided onward with x-ray monitoring until the tip reaches the blockage.

Once in position, the balloon is inflated, effectively opening the artery and then the catheter is removed.

Studies in younger patients have shown that complications are less likely if the catheter is inserted into a blood vessel in the wrist rather than the groin. However, it was unclear if the wrist site was also best for patients in their 80s and older, who often have blood vessel abnormalities that make this approach more technically challenging.

As reported in the American Journal of Cardiology, Dr. Yves Louvard, from Institut Hospitalier Jacques Cartier, Massy, France and colleagues compared the rate of complications between 192 wrist-accessed and 185 groin-accessed octogenarians.

The rate of complications delaying hospital release in the wrist group was 1.6 percent, much lower than the rate in the groin group - 6.5 percent - the authors report. Moreover, the wrist approach did not diminish the effectiveness of angioplasty and was only associated with a slight increase in procedure time.

Except for one, all of the complications were confined to the groin group, the researchers point out.

The findings indicate "beyond the shadow of a doubt" the superiority of the wrist approach with respect to complications, the authors conclude.

SOURCE: American Journal of Cardiology, November 1, 2004.