Dr Shigeru prefers going up your wrist

2009/11/22

By Marc Lourdes

KUALA LUMPUR: Even in his surgical scrubs, Dr Shigeru Saito seems less like the world-renowned surgeon he is and more like a martial arts master. With close-cropped hair, facial stubble and a purring voice, he comes across as a person who would be more likely to dish out deadly karate chops than help pioneer a form of angioplasty that allows patients to leave the hospital the day they undergo the procedure.

The 59-year-old Japanese surgeon has been promoting Trans-Radial Coronary Intervention (TRI) since the 1990s.

It is an angioplasty method in which the angioplasty balloon is inserted through a catheter in the arm’s radial artery, instead of how it is normally done — through the groin’s femoral artery.

Using this method allows the patient to be mobile immediately after the procedure and discharged the same day.

While credit for developing this approach to angioplasty has to be given to Dutch surgeon, Dr Ferdinand Kiemeneij, it is Dr Saito, of Shonan Kamakura General Hospital in Japan, that has played the largest part in introducing it to the world.

Dr Shigeru Saito helped evelop Trans-Radial Coronary Intervention

“Kiemeneij is one ofmy best friends. He created the procedure in 1992. Unfortunately, he couldn’t popularise it, so I’m promoting it everywhere.

“He’s the mother, I’m the father,” Dr Saito said with a laugh during an interview at the National Heart Institute (IJN) yesterday.

He is in Malaysia for the third Asian TRI Seminar, being held yesterday and today.

The veteran surgeon taught local doctors a new TRI technique, which is especially important for Asian patients.

The technique calls for using a catheter with an outer diameter of only 1.6mm, as opposed to the regular 2.5mm.

This is crucial to the 10 per cent of men and 20 per cent of women whose radial arteries are too small for regular-sized catheters.

He also conducted two angioplasties, one a simple halfhour session on a 37-year-old, the other, a tough procedure on a 52-year-old diabetic man whose vessels were blocked and hardened. Both were successful.

While Dr Saito admitted that the TRI is a more difficult technique for doctors to master, he said its benefits were obvious.

“This approach is difficult to learn. The femoral artery is this big,” he said, lifting up his little finger to illustrate his point.

“But, the radial aretery is only about 2mm to 3mm thick.

The procedure is more difficult and doctors have to use finer devices.” The payoff, though, is that patients can move about, eat and go to the toilet by themselves, making life easier for themselves as well as hospital staff.

Secondly, the early discharge has economic benefits for the patient and in IJN’s case, is better for the hospital too, as it frees up beds.

Dr Saito said when he first brought the technique to Malaysia, there were only about 100 angioplasties done a year. Today, there are 2,400 to 2,500 such procedures, about 40 per cent of them TRIs.

The TRI mortality rate, at 0.75 per cent, is the same as regular angioplasties and stands up to the Cleveland benchmark of 0.7 per cent.

IJN cardiology department head Datuk Dr Rosli Mohd Ali said there were more than 20 IJN doctors capable of carrying out TRIs.

“It’s not that difficult actually.

There’s always that learning curve when it comes to every new technology. But if youre persistent, you’ll master it eventually,”