PCI preference -- will that be an arm or a leg?

"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 75 and people undergoing PCI for acute coronary syndrome," says Rao. He says previous studies have also shown that r-PCI may cost less because it can mean shorter time in the hospital for some patients.

A decade's worth of skilled training and technical advances in stent design has contributed to an increased safety profile for most stenting procedures. But Rao says bleeding can be a complication in about 10 percent of some procedures. While most bleeding is minor, such bleeding can be life-threatening in a small number of cases. PCI also carries a slight risk of death from blood clots or ruptured arterial walls.

Rao uses r-PCI himself almost exclusively, reserving f-PCI for three types of cases: where the catheter is too big to fit inside the radial artery; in cases where the patient has had coronary bypass surgery, which can complicate access from the left wrist; or in cases where there is no alternate blood flow to the hand.

Rao notes that r-PCI is the preferred option in Europe. He says slower acceptance of the technique in the United States may be due to normal resistance to change, resistance to having to master a new learning curve and a lack of industry effort to market new devices specially designed for r-PCI.

Colleagues contributing to the study include senior author Eric Peterson, M.D., Fang-Shu Ou, M.S., Tracy Wang, M.D., and Matthew Roe, M.D., from the Duke Clinical Research Institute; Ralph Brindis, M.D., from the Oakland Kaiser Hospital and John Rumsfeld, M.D., from the Denver VA Medical Center.