Although coronary angiography for diagnosing and treating coronary artery disease has been around for a long time, the limitation of performing the procedure through the groin makes this method… potentially unsuitable for some patients. Currently, a technique called “wrist angiography” has been developed, which Dr. Suwat Kongdamrongkiat, Cardiologist and Head of the Heart Center, Phyathai 3 Hospital explained the differences that make this new technique a better option…
Coronary Artery Disease.. and Coronary Angiography
Coronary Angiography (CAG) or contrast injection is an important diagnostic and treatment procedure for coronary artery disease. The doctor inserts a small catheter into the artery just before the heart, then injects a contrast agent through the catheter to flow into the coronary arteries and takes images to check for narrowing or blockage of the arteries. This helps determine the appropriate treatment approach, which depends on the severity of the disease, whether it is medication, balloon angioplasty, or stent placement in the coronary arteries.
“Groin Approach” – The Basic Method Everyone Uses
Coronary angiography performed through the groin (Femoral artery) uses local anesthesia without general anesthesia or surgery. This means the patient remains conscious and can communicate throughout the procedure. Although this method takes only 30-60 minutes, afterward, the patient must lie flat and keep the leg on the side of the procedure straight for about 6 hours and cannot sit or walk. In cases requiring balloon angioplasty or stent placement, these can be done immediately after. Patients can usually go home within 1-2 days and return to normal activities within a week.
More Advanced with “Wrist Angiography”
With current technological advancements, it is now possible to perform angiography through the radial artery at the wrist. Although the artery is smaller and more tortuous, equipment has been developed to be suitable for this approach, allowing diagnosis and treatment comparable to the groin approach. This method is increasingly popular; for example, in the United States between 2007-2011, the number of patients undergoing coronary angiography via the wrist increased nearly tenfold.
Choosing the Appropriate Method for the Best Treatment Outcome
Generally, the decision depends mainly on the physician performing the procedure. Some doctors primarily use the groin approach, while others increasingly use the wrist approach. The physician must be highly skilled and experienced. For example, in very obese patients or those with peripheral artery disease in the legs, the wrist approach has more advantages. However, in some cases where preserving the radial artery for other treatments such as hemodialysis or coronary artery bypass grafting (CABG) is necessary, the groin approach may be more appropriate.
Comparison Between Coronary Angiography via Wrist and Groin
| Coronary Angiography | Via Wrist | Via Groin |
| Post-procedure bed rest | Not required | About 6 hours |
| Local vascular complications | 1.4% | 3.7% |
| Success rate of diagnosis and treatment | 95% | 95% |
| Patients choosing wrist approach next time | 90% | 50% |
Phyathai 3 Hospital
