A new approach may allow people undergoing angioplasty and stenting -- used for opening up clogged heart arteries -- to get out of the hospital on the same day they have the procedure, Canadian researchers report.
“Currently, most patients spend two to three days in the hospital after angioplasty,” says researcher Olivier Bertrand, MD, PhD, a heart specialist at Laval University in Quebec City. “We propose a practice with more comfort for the patient, less risk of complications, and major cost savings due to shorter hospitalizations,” he tells WebMD.
Speaking at the annual meeting of the American Heart Association, Bertrand says his study of more than 1,000 people undergoing angioplasty and stenting shows that those who were discharged four to six hours later did as well as those who remained overnight.
Traditional Angioplasty and Stenting
About 600,000 angioplasty and stent procedures are performed each year in the U.S., he says.
Here's how the procedure works. First, a balloon-tipped catheter is inserted through an artery, usually in the leg or groin, and advanced through the circulatory system until it reaches the blocked artery of the heart. There, the balloon is inflated, flattening the plaque – the stuff clogging the artery -- against the artery wall and allowing blood to flow more easily.
A wire-mesh stent is then inserted and left in place to prop the artery open. Sometimes, a blood thinner such as Reopro is given to reduce the risk of blood clots and prevent reclosure of the blood vessel.
How the New Approach Works
Bertrand credits two innovations for the shorter hospital stays. The first, which is now standard practice at his institution, is inserting the catheter through the small radial artery in the wrist instead of the larger femoral artery in the leg.
Fewer than one in 10 American doctors use the wrist approach, mainly because of concerns that navigating the smaller vessels in the wrist and arm will be difficult and require special training, Bertrand says. “That’s a myth,” he tells WebMD.
The wrist approach carries a lower risk of bleeding at the site of insertion because the radial artery is so small, Bertrand says.
The second innovation involves giving a single injection of the blood thinner Reopro instead of the typical injection plus 12-hour IV drip, Bertrand says.
New Approach vs. Traditional Method
For the study, 1,005 people undergoing angioplasty and stenting through the artery in the wrist were divided into two groups. One group got an injection of Reopro and was sent home four to six hours later. The other people got an injection plus a 12-hour drip and were kept in the hospital overnight.
Six months later, 5.9 percent of those in the same-day group had died, had a heart attack, or needed a repeat procedure vs. 5.6 percent of those who had the traditional procedure.
Timothy Gardner, MD, a heart surgeon at Christiana Care Health Services in Wilmington, Del., says that while the findings need to be confirmed in other trials, the approach is worthy of further study. Gardner was chairman of the committee that selected studies to be highlighted at the meeting.
“They have used the radial approach for years and have proven it is safe and effective,” he tells WebMD. “Now they are suggesting that you can get the same results with a single [dose] of Reopro as you can with the longer IV-drip – while shortening the hospital stay. This is provocative.”
By Charlene Laino, reviewed by Louise Chang, MD
SOURCES: American Heart Association Scientific Sessions 2005, Dallas, Nov. 13-16, 2005. Olivier Bertrand, MD, PhD, assistant professor, faculty of medicine, Laval University, Quebec City. Timothy Gardner, MD, chairman, American Heart Association Committee on Scientific Sessions Program; medical director, Center for Heart and Vascular Health, Christiana Care Health Services, Wilmington, Del.