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Medical Profile: Transradial Catheterization equals faster patient recoveries

Beverley Nash
Saturday, Aug 1, 2009


Dr. Brian Dockery.

Dr. Brian Dockery, interventional cardiologist with Tennessee Heart, is helping Cookeville Regional provide patients a catheterization procedure that significantly reduces recovery time and is only available at four of the largest hospitals in Tennessee.

Transradial catheterization is not a new procedure – it has been used in Europe since the late 1980s. It has gained popularity in the U.S. because of the positive clinical outcomes experienced in other countries. However, there are a limited number of transradial catheterization training programs in the U.S.

Transradial catheterizations are performed using an artery in the wrist. This method was not available in the Upper Cumberland until 2008, when Dockery returned from completing a fellowship in interventional cardiology at the University of Rochester Medical Center’s Strong Heart and Vascular Center. He had begun working in Cookeville as an internist since 1999.

“The radial cath training was a bonus at Rochester,” said Dockery. “Chris Cove, who was one of the pioneers in the U.S. of this procedure, was assigned as my mentor. I was fortunate to learn from one of the best.”

Heart catheterizations are performed to clear blockage in the arteries with a balloon, or to insert a stent to hold the artery open. A hollow needle is inserted into an artery, which allows a long tube, or catheter, to be threaded from the entry point to the aorta and surrounding coronary arteries.

Previously, physicians used a femoral (groin) artery as the point of entry. However, the femoral artery is difficult to access in obese patients and is difficult to compress in all patients in order to stop the bleeding after the procedure. Also, sometimes the artery or surrounding tissue is diseased and the catheter will not easily thread through the femoral artery.

“The goal with heart catheterizations and any type of interventional procedure is to reduce complications,” said Dockery. “Though the risk is minimal, there is always a danger of puncturing an artery or damaging an aneurism. With the radial procedure, the risk is significantly reduced.”

Due to the size of the radial (wrist) artery and its location, bleeding can be quickly and easily stopped after the procedure by applying a hemoband that the patient wears for a few hours. The radial artery is close to the skin, even in obese patients, so insertion of the catheter is simple and straightforward. Another advantage is the radial artery is not close to any major nerves, so the likelihood of nicking a nerve during the procedure is very low.

Instead of requiring the patient to lie flat for four to five hours while the risk of bleeding subsides, patients can sit and walk immediately, and many can go home within a short time after surgery.

“Not everyone is a candidate for radial catheterizations,” said Dockery. “In 5 to 10 percent of patients the arteries can close down after the procedure, causing permanent damage to the hand. Because of this risk, transradial catheterizations can only be done on patients who have two healthy arteries in the wrist. We do a femoral cath on about 30 percent of our patients, because they don’t have sufficient arteries in the wrist.”

Radial catheterizations are not the only procedures helping heart patients return to good health. Dr. Bunker Stout, also with Tennessee Heart, was the first cardiac interventional cardiologist at Cookeville Regional. He and the Emergency Department physicians and staff spearheaded the development of the hospital’s Code 37 Team.

Studies show that reopening clogged arteries via balloon angioplasty can cut a patient’s risk of dying by 40 percent, but only if it is done within 90 minutes of the patient’s arrival in the emergency room, the so-called door-to-balloon time. Cookeville Regional’s Code 37 Team has developed guidelines to decrease the amount of time involved between entering the emergency room door and receiving angioplasty. Since the Code 37 Team implemented the new guidelines, door-to-balloon time has been significantly reduced.

“Last night I received a call from the ER at 1 a.m. The team was assembled and we were administering the procedure in 60 minutes from the time the patient arrived,” said Dockery. “Smith (Dr. Sullivan Smith, ER medical director) and his team know exactly what to do. The goal is to consistently be within that 90-minute window to make sure the patient has the best chance possible for a full recovery.”

Dockery is a Knoxville native. He chose Cookeville for his practice because he wanted a smaller town.

“The hospital here invested a lot of money to improve services and facilities while I was gone and especially over the past few years,” said Dockery. “Everything is state-of-the-art. There is nothing that we were doing in Rochester that we can’t do here.”

Dockery earned a medical degree from the University of Tennessee College of Medicine in Memphis. He completed his internship and residency at the University of Michigan Medical Center in Ann Arbor, Mich., and a fellowship in cardiovascular diseases at the U.T. Health Sciences Center in Memphis, in addition to a fellowship in interventional cardiology at Strong Heart and Vascular Center in
Rochester.

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