New preformed catheter and method for retrograde left atrial or complete left heart catheterization

Employing a new catheter and technique complete retrograde left heart catheterization was accomplished in 96 of 100 consecutive patients. These 96 patients included 37 with ischemic heart disease, 13 of 17 with isolated aortic valve deformities, 11 with isolated rheumatic mitral valve deformities, 10 with combined rheumatic aortic and mitral valve deformities, and 25 with other problems. The only failures were in 4 (of 27) patients with aortic valve deformities. No untoward complications occurred. The retrograde catheterization fluoroscopy time was usually less than 2 minutes. The shortest time was 44 seconds, the longest, 6 minutes and 2 seconds. These data indicate that this new catheterization method achieves safe, reliable (when the aortic valve is not deformed), simple, and rapid complete left heart catheterization. They further indicate it may be useful in assessing patients with mitral stenosis, pulmonary hypertension, hypertrophic obstructive cardiomyopathy, and left-to-right shunt problems.     

Percutaneous left brachial catheterization usingl 5-French preformed (Judkins) catheters

A method is described combining percutaneous brachial catheterization techniques with the use of 5-French (F) preformed (Judkins) catheters. This method was used in 50 patients with one unsuccessful attempt to cannulate the brachial artery. There was one lost pulse requiring surgical thrombectomy but no other cardiac, vascular, or neurologic complications. Two moderately large hematomas occurred, which resolved without sequelae. Manipulation of 5-F Judkins catheters from the left arm was found to be quite acceptable with adequate visualization of the coronary arteries in all cases. We believe this technique to be an excellent alternative to brachial cutdown or transaxillary methods in patients with severe occlusive ileofemoral disease as well as an improved technique for out-patient catheterization.     

Four French catheters for diagnostic coronary angiography.

A randomized study was conducted to assess the feasibility of 4 Fr catheters for diagnostic coronary angiograms. A total of 1,114 consecutive patients were randomized to 4 or 5 Fr catheters. Ease of use of catheters was subjectively assessed by the primary operator and the picture quality was assessed by two independent observers with a good interobserver variability (r = 0.94; P < 0.001). Predischarge local complications were recorded by the attending physician. No statistically significant difference was observed in the picture quality for the left coronary artery, right coronary artery, aorta, left ventricle, venous grafts, or renal arteries between the two groups. Fluoroscopy time (7.1 +/- 5.6 for 4 Fr vs. 6.7 +/- 5.7 min for 5 Fr) and contrast quantity (140 +/- 58 vs. 144 +/- 57 ml) were comparable between the two groups. There was a statistically significant difference in favor of the 5 Fr group as regards maneuverability of catheters (93% vs. 79%; P < 0.001), and 5 Fr pigtail catheters crossed the aortic valve easier than the 4 Fr pigtail catheters (91% vs. 81%; P < 0.001). Crossover to the other catheter size or a larger sheath was more frequent with 4 Fr catheters (33/522 vs. 3/592; P < 0.001). Median time to hemostasis was 9 min for 4 Fr and 14 min for 5 Fr (P < 0.001). Of the 4 Fr patients, 84% could be mobilized at 1 hr and 86% of 5 Fr patients at 2 hr. Significant hematomas were observed in 2% with 4 Fr or 5 Fr and small hematomas in 10% and 16%, respectively (P = NS). Time to discharge was comparable in both groups (4.0 +/- 3.2 with 4 Fr vs. 4.3 +/- 3.7 hr with 5 Fr). The 4 Fr catheters are a good alternative for diagnostic coronary angiograms. The increased difficulty in maneuverability and a need for catheter changes in 70% are compensated for in part by easier hemostasis. With increasing use and finesse of these catheters, the difficulty in maneuverability are likely to be overcome.     

Effectiveness of right or left radial approach for coronary angiography.

The transradial approach for catheterization is becoming increasingly more popular. At present, the choice of the right or left radial artery depends on the operator's preference. We examined how the laterality influenced the effectiveness of the approach. Employing Judkins-type catheters, we performed coronary angiography in 232 patients with the left approach and in 205 patients with the right approach. Although access time did not differ between the two groups of patients, the duration of catheter manipulation was shorter in the left- than in the right-approach group (11.7 +/- 5.9 vs. 9.8 +/- 4.4 min; P < 0.001). Because of the shorter duration of catheter manipulation, the total procedural duration was shorter in the left-approach group (13.7 +/- 6.4 vs. 11.4 +/- 4.8 min; P < 0.001). The fluoroscopy time was shorter in the left- than in the right-approach group (3.7 +/- 2.5 vs. 5.0 +/- 3.3 min; P < 0.001). The amount of contrast material did not differ between the groups (79 +/- 27 vs. 83 +/- 25 ml). The rate of guidewire usage to engage the coronary ostium was higher in the right- than in the left-approach group because of the severe tortuosity of the right subclavian artery (20/205 vs. 0/232; P < 0.001). Thus, for operators with significant experience, the left radial approach may provide increased procedural efficacy for coronary angiography compared to the right radial approach.     

Cardiac catheterization and coronary angiography using 5 french preformed (Judkins) catheters from the percutaneous right brachial approach: A comparative analysis with the femoral approach

This study describes a method for the performance of cardiac catheterization using 5 French preformed Judkins catheters from a percutaneous right brachial approach, and compares that technique to the more traditional percutaneous right femoral approach with 6 French catheters. One hundred consecutive patients requiring diagnostic left heart catheterization and selective coronary angiography were randomized according to femoral versus brachial arterial technique. Procedural efficiency, radiation exposure, and diagnostic film quality favored the femoral approach, while patient comfort, hemostasis time, time to ambulation, and decreased need for post-procedure nursing care favored the brachial approach. No differences were identified in complications. Cardiac catheterization from a right brachial artery percutaneous approach with 5 French preformed catheters has both advantages and disadvantages when compared with a more traditional femoral approach with 6 French catheters. Multiple factors should be considered before selecting an approach to diagnostic cardiac catheterization and each patient should be individually evaluated for determination of the optimal technique. © 1993 Wiley-Liss, Inc.     

Perforation of a side branch of the right coronary artery during selective coronary angiography using 5 french judkins catheters

In this case report the first known case of a perforation of a side branch of the right coronary artery during diagnostic coronary angiography using 5 French Judkins catheters is described which occurred by selective intubation. Although catheter placement was controlled by contrast test injection the catheter occasionally intubated the conus artery superselectively just prior to the diagnostic injection. Thus, perforation of small side branches may be encountered especially by the use of 5 French Judkins catheters. © 1995 Wiley-Liss, Inc.     

A prospective randomized study of 4.1 French catheters utilizing the percutaneous right brachial approach for the diagnosis of coronary artery disease

To determine the utility of 4.1 French (F) catheters in diagnosing coronary artery disease, 50 patients were randomized to 4.1F Multipurpose or Judkins catheters utilizing the percutaneous right brachial approach. The randomized 4.1F tip shape catheter completed the procedure in 40% of the patients, and overall the 4.1F catheters completed the catheterization in 72% of the cases. With excessive or prolonged manipulation, the catheters were noted to kink and soften and required replacement for a catheter of similar or larger size. In 28% of the cases, larger F sizes (5F and 6F) were used to complete the procedure. There was 1 (2%) procedural complication. The total procedural success (accounting for all F sizes) without clinical complication was 98%. There was no difference between the 4.1F Judkins or Multipurpose catheter shapes for coronary arteriography by either qualitative or quantitative angiographic analysis. Left ventricular opacification was improved with the 4.1F Pigtail vs. the 4.1 Multipurpose by qualitative angiographic analysis. When the 4.1F angiograms were compared by quantitative angiography in blinded, but not randomized fashion to angiograms performed with 6F Judkins catheters, there was improved opacification of the LAD and diastolic frame of the left ventriculogram with the larger catheter. This difference was not noted with qualitative angiography. This study indicates that 4.1F catheters can be utilized from the right brachial approach for the diagnosis of coronary artery disease, thus avoiding the need for supine bedrest associated with routine femoral artery catheterization while maintaining diagnostic accuracy. © 1992 Wiley-Liss, Inc.     

Arteriographic demonstration of both kinking at the origin and compression between the great vessels of an anomalous right coronary artery arising in common with a left coronary artery from above the left sinus of valsalva

Angled angiographic views demonstrated two areas of significant systolic narrowing in an anomalous right coronary artery arising in common with a left coronary artery from above the left sinus of Valsalva: (1) an ostial stenosis due to kinking as the anomalous artery turned sharply to the right after its origin from the aorta; (2) compression of the proximal segment as it coursed between the aorta and pulmonary artery. Appropriate angiographic studies to evaluate the presence of these changes may help to elucidate their significance.     

桡动脉5F共用导管与股动脉左右冠导管冠脉造影对比分析

目的比较5F共用造影导管经桡动脉和左右冠导管经股动脉行冠脉造影的优缺点。方法426例临床疑诊冠心病拟行冠状动脉造影的患者,随机分成桡动脉组218例和股动脉组208例,观察比较两组患者的冠脉造影效果。结果两组穿刺成功率比较差异无统计学意义(P>0.05);桡动脉组平均X线透视时间、手术操作时间和术后住院时间分别为(4.68±3.53)min、(18.84±12.35)min和(1.73±1.07)d,股动脉组分别为(5.98±4.12)min、(25.96±10.66)min和(3.92±2.14)d,两组比较差异有统计学意义(P<0.05);且桡动脉组局部血肿和尿潴留的发生率均较股动脉组低(P<0.01)。结论经桡动脉行冠脉造影止血容易、并发症少,且X线透视、手术操作和术后住院时间短,值得推荐使用。     

Four‐year clinical follow‐up of the XIENCE V everolimus‐eluting coronary stent system in the treatment of patients with de novo coronary artery lesions: The SPIRIT II trial

This report describes the 4‐year clinical outcomes of the SPIRIT II study, which randomized 300 patients to treatment with the XIENCE V everolimus‐eluting stent (EES), or the TAXUS paclitaxel‐eluting stent. At 4‐year clinical follow‐up, which was available in 256 (85.3%) patients, treatment with EES lead to a trend for lower rates of ischemia‐driven major adverse cardiovascular events, a composite of cardiac death, myocardial infarction, and ischemia‐driven target lesion revascularization (EES 7.7% vs. paclitaxel‐eluting stent 16.4%, P = 0.056). Treatment with EES also resulted in a trend toward lower rates of cardiac death and numerically lower rates of myocardial infarction, ischemia‐driven target lesion revascularization, and stent thrombosis. Overall, this study reports numerically fewer clinical events in patients treated with EES at 4‐year follow‐up, which is consistent with results from earlier follow‐up. © 2010 Wiley‐Liss, Inc.     

Lessons learned from the review of cardiac catheterization laboratories: A report from the laboratory survey committee of the society for cardiac angiography and interventions

The Laboratory Survey Committee of the Society for Cardiac Angiography and Interventions was created as a resource for physicians and administrators to provide comprehensive independent outside review services for cardiac catheterization laboratories. Since 1989, when the committee began its work, surveys of 23 catheterization laboratories have been completed. Our review of this experience identified several recurring problems among the laboratories. The purpose of this paper is to summarize our experience and highlight the lessons we learned in the hope that this information will benefit many other laboratories. Cathet. Cardiovasc. Intervent. 46:24–31, 1999. © 1999 Wiley-Liss, Inc.     

Multidetector CT coronary angiography for patient triage to invasive coronary angiography: Performance and cost in ambulatory patients with equivocal or suspected inaccurate noninvasive stress tests

Background : Multidetector‐CT angiography (MDCTA) differs from noninvasive stress tests by directly imaging coronary anatomy. The utility of MDCTA for invasive triage is undefined however. We evaluated MDCTA triage to invasive coronary angiography in outpatients with indeterminate or suspected inaccurate stress tests, and estimated cost savings by MDCTA in this role. Methods : Consecutive MDCTA patients were retrospectively compared with noninvasive stress tests if performed within 6 months of MDCTA. Twelve‐month clinical follow up was obtained for patients not undergoing invasive angiography, and cost using MDCTA for triage to invasive coronary angiography was calculated. Results : MDCTA was performed in 385 patients who had noninvasive stress testing. Stress tests include included treadmill (n = 37), stress echo (n = 178), and nuclear perfusion imaging (n = 170). Invasive angiography was performed in 57 (14.8%). MDCTA compared to CA showed positive and negative predictive values of 94%/100% respectively for lesions found by invasive QCA. Stress testing compared to MDCTA showed positive/negative predictive values of 100%/67% for treadmill exercise, 60%/54% for stress echo, and 59%/55% of nuclear perfusion examinations respectively. One year clinical follow up in 314 patients showed no coronary events in 98% (309) of patients. Triage to invasive angiography by MDCTA showed a 4‐fold cost reduction. Conclusions : MDCTA shows excellent performance as a triage for invasive angiography in patients with stress tests that are equivocal or thought inaccurate. A negative CTA confers good 12‐month prognosis. Substantial cost savings may accrue using MDCTA in this triage role.     

Five year trends in cardiac catheterization: A report from the registry of the society for cardiac angiography and interventions

The Society for Cardiac Angiography and Interventions has maintained a registry of cardiac catheterizations since 1979 and of percutaneous cardiac interventions since 1990. Data from 392,923 procedures (317,592 diagnostic catheterizations, 74,963 coronary interventions, and 368 valvuloplasties) for the years 199G1994 inclusive are presented. Over the 5 year period there was a trend toward same day and 23 hr discharges (19% in 1990 to 29% in 1994), and a decrease in combined right and left heart procedures from 38% to 26%. For cardiac catheterizations ionic contrast use declined from 26% of procedures to 13% in 1994. The use of ionic contrast was even lower in interventional procedures, with laboratories reporting use in 21% of procedures in 1990 dropping to 9% in 1994. Balloons were the first choice device in 92.5% of native arteries and 82.7% of grafts in 1994. For the first time in 1994 more mitral than aortic valvuloplasties were reported.     

Value of navigator echo magnetic resonance angiography in detecting occlusion/patency of arterial and venous, single and sequential coronary bypass grafts

Aim of our work was to validate magnetic resonance angiography (MRA) in detecting occlusion/patency of coronary artery bypass grafts. Twenty patients with previous history of bypass surgery and recurrent episodes of chest pain were enrolled. Two patients could not be studied (claustrophobia, erratic breathing). Thus, 18 patients with 51 bypasses were examined using a navigator echo sequence: 21 arterial grafts (six sequential) and 30 saphenous vein grafts (five sequential). All patients had undergone contrast conventional angiography 3–15 days before MRA. The magnetic resonance (MR) data set was analyzed by two independent readers blinded to the results of conventional angiography (occlusion of 12 of 51 grafts). At magnetic resonance, two bypasses of the posterior descending artery, patent at conventional angiography, could not be visualized because of imaging slab malpositioning. Interobserver concordance was 96% (47/49). Magnetic resonance and conventional angiography provided identical answers in 47 out of 49 (96%) of the examined grafts. Eleven out of 12 occluded grafts and 36 out of 37 patent grafts were correctly identified with MR. As far as occlusion is concerned, the sensitivity of MR was 91%, the specificity 97%. To summarize, a 30 min outpatient MR examination is highly reliable in determining occlusion/patency of arterial and venous, single and sequential bypasses.     

Non-invasive multislice computed tomography coronary angiography for imaging coronary arteries, stents and bypass grafts

Abstract Multislice computed tomography (MSCT) is evolving rapidly and available data suggest that MSCT coronary angiography may be a reliable and accurate non-invasive imaging modality of coronary arteries. Current generations of MSCT scanners have high sensitivity and specificity for diagnosing native coronary artery disease and coronary bypass graft occlusion. The performance of MSCT in the evaluation of stent patency is still being assessed. In comparison with conventional selective coronary angiography (SCA), MSCT is non-invasive, cheaper and it has the advantages of imaging plaque compositions as well as assessment of luminal patency. Nevertheless, the role of MSCT in the management of coronary artery disease is yet to be fully defined.     

A new catheter for angioplasty of the right coronary artery and aorto-coronary bypass grafts

We have developed a new guiding catheter for angioplasty of the right coronary artery (RCA) and venous bypass grafts (VG). This catheter is easy to manipulate, provides a good ?backup”?, and is unusually helpful in angioplasty of the RCA with a usual as well as a complex course. The catheter is equally successful in angioplasty of bypass grafts. We have used this guiding catheter for angioplasty of the RCA and VG in 27 consecutive cases. In 22 patients (81%), successful dilatation was achieved. Inadequate ?backup”? was responsible for two of the five unsuccessful angioplasties; therefore, the catheter provided a good ?backup”? in 25/27 (93%) cases. No major complication occurred in this group of patients.     

Anatomic spectrum of left coronary artery anomalies and associated mechanisms of coronary insufficiency

This is a novel re‐appraisal of an understudied and misunderstood group of important coronary anomalies. The general name of the group is “anomalous origin of the left coronary artery,” but several additional details should be included in this group of anomalies and the explanation of their pathophysiology. The most lethal form in young athletes or military recruits features intramural aortic proximal course. This comprehensive review is based on a large experience at a dedicated center for coronary artery anomalies, using evolving knowledge (over 20 years) while employing prospective and disciplined programs of evaluation and treatment, according to the nature and severity of each anomaly. The most common pathogenic mechanism of coronary dysfunction relates to intramural coronary course, with or without ectopic origin, leading to variable lateral compression and stenosis inside the aortic tunica media; this compression is present at rest and worsens with exertion. We propose that such variable and dynamic stenoses can be best studied by examining their specific anatomy and clinical presentation, stress testing, and, most importantly, in vivo evaluation by intravascular ultrasonography. Such methods should be used to support individual risk evaluation and selection among treatment options.     

Acute coronary syndrome in an anomalous mid-LAD right coronary artery: Don't forget to look twice before turning left

A 68-year-old female with past medical history of hypertension, hyperlipidemia, multiple sclerosis, diverticulitis, and tobacco use presented with 1 day of atypical chest pain after a recent diverticulitis flare. Initial workup was notable for a normal electrocardiogram but elevated high sensitivity troponin T (616 ng/L). Due to persistent symptoms, the patient was given antiplatelet therapy and taken urgently to the catheterization lab where she was found to have complete occlusion of an anomalous right coronary artery branching off the mid-left anterior descending artery. Angioplasty was performed with a drug-eluting stent and her symptoms resolved. The patient recovered well and was discharged on appropriate medical therapy. This case demonstrates a case of acute coronary syndrome in an extremely rare coronary congenital abnormality. Further research is needed on when to be suspicious for coronary anomalies on patients presenting with myocardial infarction.     

Single right coronary artery with absence of the left main coronary artery,left anterior descending artery,and circumflex artery

Single coronary artery is an extremely rare congenital coronary anomaly in which the entire coronary arterial system arises from a solitary ostium. The Lipton's classification is used for single coronary artery anomalies. Herein, we present a 72‐year‐old woman with single coronary artery anomaly admitted with atypical chest pain. Coronary angiography and multidetector computed tomography coronary angiography findings were shared.