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Wan J, Wang X, Liu S, Hou J, Zhou P, Xue Q, Wang P. A modified single-catheter approach for improving adrenal venous sampling in patients with primary aldosteronism. J Vasc Access 2023:11297298231213669. [PMID: 38053266 DOI: 10.1177/11297298231213669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVES Adrenal vein sampling (AVS) is an established procedure for assessing subtype patients with primary aldosteronism (PA). However, it is technically challenging, with high failure rates, which limits its application in clinical practice. Our study aimed to evaluate the safety and efficacy of a single-catheter modified approach for AVS. METHODS The clinical, angiographic, and procedural data of 182 consecutive patients who underwent AVS procedures between May 2020 and May 2023 were collected and analyzed. The single-catheter modified approach was performed as a single 5 F Tiger catheter with only one-time manual reshaping, which was recommended for sequential bilateral adrenal cannulations. RESULTS Of the 182 consecutive patients, 174 (95.6%) had successful bilateral adrenal cannulation. The single-catheter modified approach was successfully performed to cannulate the right adrenal vein in 176 (96.7%) patients, while another six (3.3%) patients needed at least a second manual reshaping for 5 F Tiger catheters. For left adrenal cannulation, a single-catheter modified approach was successfully used in 179 (98.4%) patients, whereas 5 F Tiger catheters with at least second-time manual reshaping were used in the remaining three (1.6%) patients. The procedural period was 15.6 ± 10.8 min, the fluoroscopy time was 4.2 ± 1.5 min, and the diagnostic contrast was 15.5 ± 4.8 mL. The incidence of procedure-related complications associated with AVS was 1.1%. The cumulative summation assessment illustrated that the learning curve for the operating procedure required up to 29 cases, indicating that the procedure time was shortened after 29 cases. CONCLUSIONS The single-catheter modified approach is an effective, safe, and feasible technique for AVS treatment. In particular, this improved method is not difficult for beginners with high technical success rates.
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Affiliation(s)
- Jindong Wan
- Department of Cardiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Xinquan Wang
- Department of Cardiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Sen Liu
- Department of Cardiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Jixin Hou
- Department of Cardiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Peng Zhou
- Department of Cardiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
| | - Qiang Xue
- Department of Cardiology, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China
| | - Peijian Wang
- Department of Cardiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Sichuan Clinical Research Center for Geriatrics, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, PR China
- Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, Sichuan, PR China
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2
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Khan Z, Besis G, Upadhyaya C, Neoh S. Can Tiger (TIG) Catheters Be a Solution to the Radial Artery Spasm (RAS) in Coronary Angioplasty? A Case-Based Report of Successful Reperfusion With the Use of 5-French (Fr) TIG Catheter and Literature Review. Cureus 2022; 14:e26334. [PMID: 35911293 PMCID: PMC9314273 DOI: 10.7759/cureus.26334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/05/2022] Open
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3
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Gender specific performance of one- compared to two-catheter concepts in transradial coronary angiography – Insights from the randomized UDDC-Radial-Trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:49-54. [DOI: 10.1016/j.carrev.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022]
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Safety and Efficacy of Four Different Diagnostic Catheter Curves Dedicated to One-Catheter Technique of Transradial Coronaro-Angiography-Prospective, Randomized Pilot Study. TRACT 1: Trans RAdial CoronaryAngiography Trial 1. J Clin Med 2021; 10:jcm10204722. [PMID: 34682845 PMCID: PMC8541157 DOI: 10.3390/jcm10204722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 12/13/2022] Open
Abstract
Transradial coronaro-angiography (TRA) can be performed with one catheter. We investigate the efficacy of four different DxTerity catheter curves dedicated to the single-catheter technique and compare this method to the standard two-catheter approach. For this prospective, single-blinded, randomized pilot study, we enrolled 100 patients. In groups 1, 2, 3, and 4, the DxTerity catheters Trapease, Ultra, Transformer and Tracker Curve, respectively, were used. In group 5 (control), standard Judkins catheters were used. The study endpoints were the percentage of optimal stability, proper ostial artery engagement and a good quality angiogram, the duration of each procedure stage, the amount of contrast, and the radiation dose. The highest rate of optimal stability was observed in groups 2 (90%) and 5 (95%). Suboptimal results with at least one episode of catheter fallout from the ostium were most frequent in group 1 (45%). The necessity of using another catheter was observed most frequently in group 4. The analysis of time frames directly depending on the catheter type revealed that the shortest time for catheter introduction and for searching coronary ostia was achieved in group 2 (Ultra). There were no differences in contrast volume and radiation dose between groups. DxTerity catheters are suitable tools to perform TRA coronary angiography. The Ultra Curve catheter demonstrated an advantage over other catheters in terms of its ostial stability rate and procedural time.
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Klimek K, Świątek M, Klocek K, Tworek M, Zwolski M, Milewski K, Janas A. Comparison of Safety and Efficiency between Tiger-2 Catheter with Right Radial Artery Access and Judkins Catheter with Left Radial Artery Access. J Clin Med 2021; 10:jcm10174020. [PMID: 34501468 PMCID: PMC8432482 DOI: 10.3390/jcm10174020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 12/05/2022] Open
Abstract
We sought to compare the safety and efficiency of Tiger-2 in the right radial and Judkins catheter in the left radial access. We retrospectively collected data of 487 patients, involving 172 patients after coronary angiography with Judkins on the left radial artery and 315 patients with Tiger-2 on the right radial artery access. There were no differences in baseline characteristics, except for hypertension ratio and mean age. There was a difference in pulse absence on the radial artery. The volume of contrast used was higher in the Judkins group. Both groups differed in the amount of drugs administered (NTG and heparin). Fluorescence times were comparable between groups. Radiation dosage and AK was significantly greater in the Tiger-2 group. The Tiger-2 catheters were significantly more often changed to another type of catheter (100 changes) than the Judkins (12 changes). However, there was no statistical difference in access site change. Judkins with left radial access seems to be a safer option because of the lower radiation exposure and less incidence of complications than Tiger-2 with right radial access, however, it requires a higher volume of contrast.
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Affiliation(s)
- Katarzyna Klimek
- Center of Cardiovascular Research and Development American Heart of Poland, 40-028 Katowice, Poland; (K.K.); (K.K.); (M.T.); (M.Z.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Mateusz Świątek
- Center of Cardiovascular Research and Development American Heart of Poland, 40-028 Katowice, Poland; (K.K.); (K.K.); (M.T.); (M.Z.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
- Correspondence:
| | - Konrad Klocek
- Center of Cardiovascular Research and Development American Heart of Poland, 40-028 Katowice, Poland; (K.K.); (K.K.); (M.T.); (M.Z.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Michał Tworek
- Center of Cardiovascular Research and Development American Heart of Poland, 40-028 Katowice, Poland; (K.K.); (K.K.); (M.T.); (M.Z.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Maciej Zwolski
- Center of Cardiovascular Research and Development American Heart of Poland, 40-028 Katowice, Poland; (K.K.); (K.K.); (M.T.); (M.Z.)
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Krzysztof Milewski
- The Jerzy Kukuczka Academy of Physical Education, 40-959 Katowice, Poland;
| | - Adam Janas
- Andrzej Frycz Modrzewski Kraków University, 30-075 Kraków, Poland;
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6
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Riangwiwat T, Blankenship JC. Vascular Complications of Transradial Access for Cardiac Catheterization. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2020.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transradial access has been increasingly adopted for cardiac catheterization. It is crucial for operators to recognize potential vascular complications associated with radial artery access. Prevention, early detection, and prompt treatment of vascular complications are essential to prevent serious morbidities. This review aims to raise awareness of transradial access vascular complications. Radial artery spasm is treated with intra-arterial verapamil and/or nitroglycerine. Hemorrhagic complications, such as perforation, hematoma, arteriovenous fistula, and pseudoaneurysm, are treated with prolonged compression. Patent hemostasis and adequate anticoagulation are used to prevent radial artery occlusion. Hand ischemia is a rare complication not associated with abnormal results of the Allen or Barbeau test, and can be treated with intra-arterial verapamil, IV heparin, and IV diltiazem. Finally, an attentive monitoring protocol for the timely detection of vascular complications should be implemented in daily practice.
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7
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Case BC, Yerasi C, Forrestal BJ, Chezar-Azerrad C, Khan JM, Khalid N, Shlofmitz E, Chen Y, Musallam A, Waksman R, Hashim H. Right transradial coronary angiography in the setting of tortuous brachiocephalic/thoracic aorta ("elephant head"): Impact on fluoroscopy time and contrast use. Catheter Cardiovasc Interv 2021; 99:418-423. [PMID: 33491870 DOI: 10.1002/ccd.29470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/19/2020] [Accepted: 12/26/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Assess the impact on fluoroscopy time and contrast use in patients with tortuous brachiocephalic/thoracic aortas undergoing right transradial coronary angiography (RTCA) and provide strategies to manage. BACKGROUND Unfavorable anatomy with severe brachiocephalic/thoracic tortuosity, referred to as an "elephant head," remains a significant obstacle for RTCA. METHODS We reviewed the coronary angiograms of patients who underwent RTCA and had tortuous aortas. Angiography was attempted first using a universal catheter (Tiger) and switched to a left coronary specific catheter (Judkins Left [JL]) if challenging. Fluoroscopy time, contrast volume, and greatest distance from the patient's midline to the catheter in the aorta were recorded. RESULTS Forty-nine patients (62.6 ± 12.0 years, 69.4% male) were included. Fifteen (30.6%) patients underwent successful angiography with a Tiger catheter; 34 (69.4%) patients required switching to JL catheter. The average distance of Tiger catheters to the midline of the spine was 0.78 ± 0.41 cm versus 1.28 ± 0.44 cm (p = .001) in JL catheters. Tiger catheter use resulted in less fluoroscopy time (6.48 ± 4.73 min) and contrast use (58.87 ± 43.53 ml) than in cases switched to JL (13.26 ± 10.76 min [p = .026]; 86.5 ± 69.95 ml [(p = .017]). CONCLUSIONS For patients undergoing RTCA with significant brachiocephalic/thoracic aorta tortuosity, "elephant head," a Tiger catheter can be used efficiently for curvatures <1 cm from the middle of the spine. We propose that for curvatures >1 cm, operators should consider immediately switching to a JL catheter.
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Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Nauman Khalid
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Yuefeng Chen
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Anees Musallam
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Hayder Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
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8
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Blankenship JC. One or two diagnostic catheters with radial access: Does single yield celerity or double cause trouble? Catheter Cardiovasc Interv 2020; 96:283-284. [PMID: 32797737 DOI: 10.1002/ccd.29163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/05/2022]
Abstract
One-third of interventionalists still use dedicated left and right coronary catheters for diagnostic angiography with radial access, despite some evidence that a single "universal" catheter strategy is superior. This meta-analysis of seven randomized controlled studies of one- versus two-catheter strategies with radial access showed no differences in procedural time, fluoroscopy time, or contrast use. Use of an additional catheter was more frequent with the one-catheter strategy but radial spasm was more common with a two-catheter strategy. This meta-analysis did not address cost, complication rates, or radial occlusion rates. Differences in these factors, if found in future studies, may yet prove one strategy or the other to be superior.
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Affiliation(s)
- James C Blankenship
- Department of Internal Medicine, Cardiology Division, University of New Mexico, Albuquerque, New Mexico
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9
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Li H, Liu Y, Huang J, Liu Y, Zhu Y. Association of genetic variants in lncRNA GAS5/miR-21/mTOR axis with risk and prognosis of coronary artery disease among a Chinese population. J Clin Lab Anal 2020; 34:e23430. [PMID: 32557866 PMCID: PMC7595889 DOI: 10.1002/jcla.23430] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 12/31/2022] Open
Abstract
Background Allowing for the significance of single nucleotide polymorphisms (SNPs) in reflecting disease risk, this investigation attempted to uncover whether SNPs situated in lncRNA GAS5/miR‐21/mTOR axis were associated with risk and prognosis of coronary heart disease (CHD) among a Chinese Han population. Methods Altogether 436 patients with CHD were recruited as cases, and meanwhile, 471 healthy volunteers were included into the control group. Besides, SNPs of GAS5/MIR‐21/mTOR axis were genotyped utilizing mass spectrometry. Chi‐square test was applied to figure out SNPs that were strongly associated with CHD risk and prognosis, and combined effects of SNPs and environmental parameters on CHD risk were evaluated through multifactor dimensionality reduction (MDR) model. Results Single nucleotide polymorphisms of GAS5 (ie, rs2067079 and rs6790), MIR‐21 (ie, rs1292037), and mTOR (rs2295080, rs2536, and rs1034528) were associated with susceptibility to CHD, and also Gensini score change of patients with CHD (P < .05). MDR results further demonstrated that rs2067079 and rs2536 were strongly interactive in elevating CHD risk (P < .05), while smoking, rs6790 and rs2295080 showed powerful reciprocity in predicting Gensini score change of patients with CHD (P < .05). Conclusion Single nucleotide polymorphisms of lncRNA GAS5/miR‐21/mTOR axis might interact with smoking to regulate CHD risk, which was conducive to diagnosis and prognostic anticipation of CHD.
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Affiliation(s)
- Hu Li
- Department of Cardiology, The First Naval Hospital of Southern Theater Command, Zhanjiang City, China
| | - Yingxue Liu
- Department of Outpatient, The First Naval Hospital of Southern Theater Command, Zhanjiang City, China
| | - Jinyan Huang
- Department of Cardiology, The First Naval Hospital of Southern Theater Command, Zhanjiang City, China
| | - Yu Liu
- Department of Cardiology, The First Naval Hospital of Southern Theater Command, Zhanjiang City, China
| | - Yufeng Zhu
- Department of Cardiology, The First Naval Hospital of Southern Theater Command, Zhanjiang City, China
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10
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Costa-Mateu J, Fernández-Rodríguez D, Rivera K, Casanova J, Irigaray P, Zielonka M, Pereyra-Acha E, Aldomá A, Worner F. Impact of One-Catheter Strategy with TIG I Catheter on Coronary Catheterization Performance and Economic Costs. Arq Bras Cardiol 2019; 113:960-968. [PMID: 31800721 PMCID: PMC7020970 DOI: 10.5935/abc.20190232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 04/24/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Coronary angiography with two catheters is the traditional strategy for diagnostic coronary procedures. TIG I catheter permits to cannulate both coronary arteries, avoiding exchanging catheters during coronary angiography by transradial access. OBJECTIVE The aim of this study is to evaluate the impact of one-catheter strategy, by avoiding catheter exchange, on coronary catheterization performance and economic costs. METHODS Transradial coronary diagnostic procedures conducted from January 2013 to June 2017 were collected. One-catheter strategy (TIG I catheter) and two-catheter strategy (left and right Judkins catheters) were compared. The volume of iodinated contrast administered was the primary endpoint. Secondary endpoints included radial spasm, procedural duration (fluoroscopy time) and exposure to ionizing radiation (dose-area product and air kerma). Direct economic costs were also evaluated. For statistical analyses, two-tailed p-values < 0.05 were considered statistically significant. RESULTS From a total of 1,953 procedures in 1,829 patients, 252 procedures were assigned to one-catheter strategy and 1,701 procedures to two-catheter strategy. There were no differences in baseline characteristics between the groups. One-catheter strategy required less iodinated contrast [primary endpoint; (60-105)-mL vs. 92 (64-120)-mL; p < 0.001] than the two-catheter strategy. Also, the one-catheter group presented less radial spasm (5.2% vs. 9.3%, p = 0.022) and shorter fluoroscopy time [3.9 (2.2-8.0)-min vs. 4.8 (2.9-8.3)-min, p = 0.001] and saved costs [149 (140-160)-€/procedure vs. 171 (160-183)-€/procedure; p < 0.001]. No differences in dose-area product and air kerma were detected between the groups. CONCLUSIONS One-catheter strategy, with TIG I catheter, improves coronary catheterization performance and reduces economic costs compared to traditional two-catheter strategy in patients referred for coronary angiography.
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Affiliation(s)
- Joan Costa-Mateu
- Cardiology Department, University Hospital Arnau de Vilanova, IRB, University of Lleida, Lleida - Spain
| | - Diego Fernández-Rodríguez
- Cardiology Department, University Hospital Arnau de Vilanova, IRB, University of Lleida, Lleida - Spain
| | - Kristian Rivera
- Cardiology Department, University Hospital Arnau de Vilanova, IRB, University of Lleida, Lleida - Spain
| | - Juan Casanova
- Cardiology Department, University Hospital Arnau de Vilanova, IRB, University of Lleida, Lleida - Spain
| | - Patricia Irigaray
- Cardiology Department, University Hospital Arnau de Vilanova, IRB, University of Lleida, Lleida - Spain
| | - Marta Zielonka
- Cardiology Department, University Hospital Arnau de Vilanova, IRB, University of Lleida, Lleida - Spain
| | - Eduardo Pereyra-Acha
- Cardiology Department, University Hospital Arnau de Vilanova, IRB, University of Lleida, Lleida - Spain
| | - Albina Aldomá
- Cardiology Department, University Hospital Arnau de Vilanova, IRB, University of Lleida, Lleida - Spain
| | - Fernando Worner
- Cardiology Department, University Hospital Arnau de Vilanova, IRB, University of Lleida, Lleida - Spain
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11
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Medeiros CR. One Catheter, Two Coronaries. Haven't We Seen This Before? Arq Bras Cardiol 2019; 113:969. [PMID: 31800722 PMCID: PMC7020963 DOI: 10.36660/abc.20190684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Cesar Rocha Medeiros
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brazil.,Hospital Badim, Rio de Janeiro, RJ - Brazil.,Hospital Unimed, Rio de Janeiro, RJ - Brazil
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12
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Alushi B, Lauten A, Ndrepepa G, Leistner DM, Kufner S, Xhepa E, Landmesser U, Kastrati A, Cassese S. Procedural and clinical performance of dual- versus single-catheter strategy for transradial coronary angiography: A meta-analysis of randomized trials. Catheter Cardiovasc Interv 2019; 96:276-282. [PMID: 31448867 DOI: 10.1002/ccd.28458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 08/12/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We sought to compare the procedural and clinical performance of dual- versus single-catheter strategy for transradial coronary angiography. BACKGROUND The radial artery (RA) is recommended as the vascular access of choice in patients undergoing coronary angiography and intervention. The procedural and clinical performance of dual- versus single-catheter strategy in patients undergoing transradial coronary angiography remains a matter of debate. METHODS This is a study-level meta-analysis of randomized trials. The primary outcome was procedure time. The main secondary outcome was fluoroscopy time. Other outcomes of interest were contrast volume, crossover to other catheter strategy and RA spasm. RESULTS A total of 2,062 patients (978 randomly assigned to dual-catheter and 1,084 to single-catheter strategy) included in seven trials were available for the quantitative synthesis. A dual-catheter strategy was associated with procedure time (standardized mean difference [95% confidence intervals (CI)], 0.55 [-0.69, 1.78]; p = .32), fluoroscopy time (-0.36 [-2.39, 1.67]; p = .68) and contrast volume (-0.93 [-3.79, 1.94]; p = .44) comparable to a single-catheter strategy. The risk for crossover was lower (risk ratio [95% CI], 0.14 [0.03, 0.70]; p = .025) while the risk for RA spasm was higher (1.81 [1.54, 2.12]; p < .001) among patients assigned to dual- versus single-catheter strategy. CONCLUSIONS This meta-analysis provides evidence for a comparable procedural performance of either dual- or single-catheter strategy for transradial coronary angiography. The fewer crossovers with dual-catheter strategy occur at the expense of more frequent radial artery spasm.
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Affiliation(s)
- Brunilda Alushi
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany
| | - Alexander Lauten
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - David M Leistner
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ulf Landmesser
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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13
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Schneider VS, Lübking L, Stähli BE, Skurk C, Lauten A, Mochmann HC, Schauerte P, Riedel M, Steinbeck L, Rauch-Kröhnert U, Klotsche J, Landmesser U, Fröhlich G, Leistner DM. Performance of One- Compared With Two-Catheter Concepts in Transradial Coronary Angiography (from the Randomized Use of Different Diagnostic Catheters-Radial-Trial). Am J Cardiol 2018; 122:1647-1651. [PMID: 30217374 DOI: 10.1016/j.amjcard.2018.07.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/21/2018] [Accepted: 07/31/2018] [Indexed: 12/15/2022]
Abstract
The Use of Different Diagnostic Catheters-Radial-Trial sought to compare the safety and efficacy of one-catheter concepts (OCC) using Tiger II or BLK catheters with two-catheter concepts (TCC) using standard Judkins catheters for transradial coronary angiography. A total of 300 patients planed for coronary angiography were enrolled into this single-center, single-blinded trial. Patients were randomized in a 2:1 ratio to either OCC by Tiger II (n = 100) and BLK (n = 100) or TCC by Judkins (n = 100) catheters. Primary end point was time required to perform a complete coronary angiography. Coronary angiography duration was 603 ± 29 seconds and 552 ± 26 sec in the OCC and the TCC groups (p = 0.052). Fluoroscopy time was longer in the OCC (408 ± 28 sec) as compared with the TCC group (258 ± 28 sec, p = 0.009) and the amount of contrast volume used significantly higher (98 ± 5 ml vs 67 ± 4 ml, p < 0.001). Crossover rates were increased in the OCC as compared with the TCC group (37% vs 4%, p < 0.001). These effects were observed irrespective of OCC catheter type. In conclusion, this study demonstrates that OCC do not reduce angiography time, but are associated with an increased amount of contrast volume and longer fluoroscopy time as compared with TCC.
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Affiliation(s)
- Vera S Schneider
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Laura Lübking
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Alexander Lauten
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Hans-Christian Mochmann
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany
| | - Patrick Schauerte
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany
| | - Matthias Riedel
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Lisa Steinbeck
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Ursula Rauch-Kröhnert
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Center Berlin, Berlin, Germany; Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charite University Medicine Berlin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Georg Fröhlich
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - David M Leistner
- Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany.
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