Wrist Catheterization for Heart Biopsies is Catching On

Originally Published MDDI June 2004

R&D DIGEST

Erik Swain

A Penn State Cardiovascular Center team has found that heart biopsies performed via catheterization in the wrist can reduce patient discomfort. Catheterization is usually done through the groin or neck. If the procedure catches on, it could lead to refinements in catheter technology.

Wrist catheterization is a common procedure in Europe, Canada, and other nations, but not in the United States. Previous studies have shown that patients who had wrist catheterization recover more quickly than those who had neck or groin catheterization. But even abroad, the technique is rarely used for heart biopsies because its effectiveness for that procedure had never been studied. That has now been changed, as the six-person Penn State team presented its findings at the Society of Cardiac Angiography and Intervention annual meeting in April.

“Some patients who've suffered with heart problems for many years can have severe scarring in the veins and arteries in the groin and neck, making it difficult to retrieve the sample of heart tissue,” said Ian Gilchrist, a member of the team and a professor at the Penn State College of Medicine (State College, PA). “Knowing that we can obtain the biopsy sample through wrist catheterization affords patients an alternative.”

A doctor on the Penn State staff learned about wrist catheterization on a visit to Montreal in 1996. The rest of the staff adopted the method quickly for simpler heart procedures. They began experimenting with it for biopsies at the urging of patients who had undergone so much groin or neck catheterization that it was becoming ineffective and painful, Gilchrist said. 

In addition to improving patient comfort, he said, wrist catheterization presents fewer issues with bleeding and does not require patients to stop using blood-thinning drugs before the procedure. Patients who have large-enough arm veins or a strong wrist pulse are the best candidates for it. Obese patients with excess fat around groin veins are also good candidates.

Wrist catheterization has not caught on in the United States because it “has a bit of a learning curve” and because there is no commercial effort driving it, Gilchrist said. “It's not considered a distinct market niche into which a company could sell a brand-new product,” he explained. By contrast, he said, there are aggressive sales efforts for closure devices related to groin catheterization. 

However, wrist catheterization is usually done with the same equipment as groin catheterization, and a catheter designed specifically for the wrist might help the procedure become more effective, Gilchrist noted. 

“The technology is out there that would make a more continuous slide into the smaller vessels in the arm,” he said. “Applying a hydrophilic coating to the catheter might work.” 

Another issue, he said, is “how to hold the site after you pull the catheter out.” Currently doctors put a band around a cotton cloth. But, he said, there may be an opportunity to develop a better method.

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