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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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A novel predictor of radial spasm: arterial stiffness. Blood Press Monit 2019; 23:253-259. [PMID: 29985200 DOI: 10.1097/mbp.0000000000000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In this study, we aimed to assess the relationship between radial artery spasm (RAS) and arterial stiffness (AS) measured by the oscillometric method. MATERIALS AND METHODS A total of 123 consecutive patients scheduled for elective coronary angiography in a single default radial center were enrolled for the study. AS [namely, augmentation pressure; augmentation index (AIx); and pulse wave velocity] was assessed using a validated oscillometric device (Mobil-O-Graph NG 24 h PWA). Central arterial pressures were also recorded. In the cath lab, the number of puncture attempts, total procedural time (TPT), and largest catheter size were noted. If greater than two catheters were required to complete imaging, it was additionally specified. RAS was considered to exist if two or more of predefined clinical features were present. RESULTS RAS was observed in 20 (16.3%) patients. Patients were divided into two distinct groups in terms of the occurence of RAS. In the RAS(+) group, the proportion of hypertensive individuals was significantly higher, whereas there were fewer smokers. With respect to operational data, TPT (24.3±9.8 vs. 29.3±9.1 mins; P=0.038) and procedures carried out with more than one puncture attempts were significantly higher in the RAS(+) group. Among all oscillometric parameters, augmentation pressure, AIx, and PR were found to be higher in the RAS(+) group. According to multivariate analysis, TPT (P=0.029) and AIx (odds ratio: 1.044, 95% confidence interval=0.977-1.117; P=0.009) were found to be independent predictors of RAS. CONCLUSION Along with conventional risk factors, AS assessment, as a practical, noninvasive method, may help to predict RAS in angiographic procedures.
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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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Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J, Drachman DE, Valle JA, Rhodes D, Gilchrist IC. An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association. Circ Cardiovasc Interv 2019; 11:e000035. [PMID: 30354598 DOI: 10.1161/hcv.0000000000000035] [Citation(s) in RCA: 311] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transradial artery access for percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access, especially in patients with acute coronary syndromes. A growing body of evidence supports adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this scientific statement is to propose and support a "radial-first" strategy in the United States for patients with acute coronary syndromes. This document also provides an update to previously published statements on transradial artery access technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes.
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Shroff AR, Fernandez C, Vidovich MI, Rao SV, Cowley M, Bertrand OF, Patel TM, Pancholy SB. Contemporary transradial access practices: Results of the second international survey. Catheter Cardiovasc Interv 2018; 93:1276-1287. [PMID: 30456913 DOI: 10.1002/ccd.27989] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To gain insight into current practice of transradial angiography and intervention in the United States and around the world. BACKGROUND Transradial access (TRA) has grown worldwide. In a prior survey, there was significant practice variation and there was minimal US participation which limited the generalizability to US operators. METHODS We used an internet-based survey software program to solicit input from practicing interventional cardiologists from the United States and around the world. US operators were compared with outside the United States (OUS) operators and respondent-level comparisons were made with the prior survey to assess for temporal changes in practice. RESULTS Between August 2016 and January 1, 2017, 125 interventional cardiologists completed the survey representing 91 countries with the United States having 449 (39.9%) respondents. Preprocedure, noninvasive testing for collateral circulation is used more commonly in the United States (54.1%) than around the world (26.6%) but its use has decreased since 2010. In the US, 48.8% of operators never use ultrasound and 92.6% of OUS operators never use it; only 4.4% overall use ultrasound in >50% of cases. Use of bivalirudin has decreased in the US and OUS. Nearly, 30% of operators do not assess for radial artery patency following hemostasis. US respondents used TRA less commonly for primary PCI for STEMI than their global counterparts. CONCLUSIONS There is wide variation in how TRA procedures are performed including relatively low rates of adherence to practices that are known to improve outcomes. Further education aimed at increasing use of best practices will impact patient outcomes.
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Affiliation(s)
| | | | | | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina
| | - Michael Cowley
- Virginia Commonwealth University Medical Center, Richmond, Virginia
| | | | | | - Samir B Pancholy
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
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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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Villablanca P, Shah B. Size Matters: Moving Toward a Slender Transradial Artery Approach. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:401-402. [PMID: 29941180 DOI: 10.1016/j.carrev.2018.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Pedro Villablanca
- VA New York Harbor Health Care System (Manhattan Campus) and NYU School of Medicine, New York, NY
| | - Binita Shah
- VA New York Harbor Health Care System (Manhattan Campus) and NYU School of Medicine, New York, NY.
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Xanthopoulou I, Stavrou K, Davlouros P, Tsigkas G, Koufou E, Almpanis G, Koutouzis M, Tsiafoutis I, Perperis A, Moulias A, Koutsogiannis N, Hahalis G. Randomised comparison of JUDkins vs. tiGEr catheter in coronary angiography via the right radial artery: the JUDGE study. EUROINTERVENTION 2018; 13:1950-1958. [PMID: 29061547 DOI: 10.4244/eij-d-17-00699] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to compare the performance of the Tiger-II with Judkins 3.5L/4R catheters in coronary angiography (CAG) via the transradial approach (TRA). METHODS AND RESULTS Consecutive patients undergoing non-urgent CAG via the right TRA were randomised to either the Tiger-II (Terumo) or Judkins (3.5L/4R; Medtronic) 5 Fr catheters; 320 patients in each group were randomised. Catheter or access site change was required in 57 (17.8%) vs. 68 (21.3%) patients allocated to the Tiger-II and Judkins group, respectively (p=0.3). The study's primary endpoint of contrast volume (ml) used until completion of CAG was lower for Tiger-II vs. Judkins group: 66.8 (54.0-82.0) vs. 73.4 (60.0-94.1), p<0.001. Angiography, fluoroscopy time (min) and severe spasm rate were also significantly lower for Tiger-II vs. Judkins group: 5.52 (4.17-7.32) vs. 6.85 (5.15-9.63), p<0.00, 2.01 (1.32-3.13) vs. 2.24 (1.50-3.50), p=0.01 and 6 (2.8%) vs. 39 (12.2%), p<0.001, respectively. The Tiger-II catheter obtained better opacification grade for the right coronary artery (RCA): 4.0 (4.0-4.0) vs. 4.0 (3.0-4.0), p=0.02, but slightly compromised opacification of the left anterior descending (LAD) and left circumflex (LCX) arteries compared with the Judkins group: 3.75 (3.0-4.0) vs. 4.0 (3.5-4.0), p<0.001, and 3.78 (3.6-4.0) vs. 4.0 (3.6-4.0), p<0.001, respectively. CONCLUSIONS The Tiger-II was found superior to the Judkins 3.5L/4R regarding contrast volume use, procedural and fluoroscopy time, spasm rate and RCA imaging, and inferior regarding LAD and LCX imaging.
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Seto AH, Kern MJ. One catheter or two? Tomayto or Tomahto? Catheter Cardiovasc Interv 2017; 90:249-250. [PMID: 28805035 DOI: 10.1002/ccd.27225] [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: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022]
Abstract
This retrospective study compares the performance of transradial diagnostic procedures using the single versus Judkins catheter approach. The Judkins approach had a 15% lower patient radiation exposure than single catheter approach while fluoroscopy time was comparable. Future studies of comparing such techniques may always be limited by operator preference, experience, and comfort.
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Affiliation(s)
- Arnold H Seto
- Division of Cardiology, Department of Medicine, Veterans Affairs Long Beach Healthcare System
| | - Morton J Kern
- Division of Cardiology, Department of Medicine, Veterans Affairs Long Beach Healthcare System
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Operator radiation exposure during transradial coronary angiography. Herz 2017; 43:535-542. [DOI: 10.1007/s00059-017-4595-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/02/2017] [Accepted: 06/17/2017] [Indexed: 11/28/2022]
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Aznaouridis K, Masoura C, Kastellanos S, Alahmar A. Inadvertent cardiac phlebography. World J Cardiol 2017; 9:558-561. [PMID: 28706592 PMCID: PMC5491474 DOI: 10.4330/wjc.v9.i6.558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/10/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
We are reporting a case of a 80-year-old lady with effort angina who underwent coronary angiography through the right radial artery, using a dedicated radial multipurpose 5 French Optitorque Tiger catheter. The catheter was advanced into the left ventricle and a left ventriculogram was obtained, while the catheter appeared optimally placed at the centre of the ventricle and the pressure waveform was normal. A large posterior interventricular vein draining into the right atrium was opacified, presumably because the catheter’s end hole inadvertently cannulated an endocardial opening of a small thebesian vein, with subsequent retrograde filling of the epicardial vein. Our case suggests that caution is needed when a dedicated radial catheter with both an end-hole and a side hole is used for a ventriculogram, as a normal left ventricular pressure waveform does not exclude malposition of the end-hole against the ventricular wall.
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