Erden Ismail, Golcuk Ebru, Bozyel Serdar, Erden Emine Cakcak, Balaban Yakup, Yalın Kivanc, Turan Burak
Department of Cardiology, VM Medicalpark Kocaeli Hospital, Kocaeli, Turkey.
Department of Cardiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
J Interv Cardiol. 2017 Feb;30(1):24-32. doi: 10.1111/joic.12350. Epub 2016 Dec 2.
To investigate safety and efficacy of specialized hand-modified "Jacky-Like" catheter (JLC) as a single dual-purpose catheter in transradial coronary angiography.
Patients over 18 years undergoing diagnostic CAG through right radial artery (RRA) were prospectively enrolled. Procedures were performed with a single JLC modified from a left Judkins (JL) 3.5 catheter or by using 2-catheter approach (2C). Procedures with coronary artery bypass grafts or ventricular angiographies were excluded from the study. Three hundred and eighty-seven transradial procedures were performed successfully. One hundred and ninety-four procedures were performed with 2C and 193 procedures with a JLC. Inability to use intended catheters, total fluoroscopic time in minutes, the consumption of contrast medium in milliliter, development of radial artery spasm (RAS), and radial artery occlusion (RAO) were evaluated.
In the 2C group, angiography was successfully performed on the RCA of 191 patients (98.9%) and on LCA in 192 patients (99.4%). In the JLC group, angiography was successfully performed on the RCA and LCA of 193 (99.4%) and 174 (89.6%) patients, respectively. Utilization of supplemental catheters was significantly greater in the JLC group (21; 10.8%) versus the 2C group (3; 1.5% P = 0.001). Mean fluoroscopy time was shorter in the JLC group (2.0 ± 2.3 min vs. 2.3 ± 1.5 min; P = 0.043). Mean procedure time was also decreased with JLC but did not reach statistical significance (5.7 ± 3.1 min vs. 6.2 ± 2.5 min; P = 0.081). When additional time for reshaping the JLC was not taken into account, mean procedure time was significantly decreased in the JLC group (5.6 ± 2.9 min vs. 6.2 ± 2.4 min; P = 0.031). There was a trend toward lower incidence of consumption of contrast medium in the 2C group (49 ± 13 mL vs. 52 ± 18 mL; P = 0.061). RAS was observed more frequently in the 2C group (11.3% vs. 21.7%, P = 0.005). There was a trend toward high incidence of RAO in the 2C group (4.1 vs. 8.3% P = 0.064).
In transradial procedures from RRA, a JLC catheter can be very effective when dedicated dual-purpose catheter is not available.
探讨特制手工改良的“类杰基”导管（JLC）作为单根两用导管用于桡动脉冠状动脉造影的安全性和有效性。
前瞻性纳入年龄超过18岁、经右桡动脉（RRA）行诊断性冠状动脉造影（CAG）的患者。使用从左Judkins（JL）3.5导管改良而来的单根JLC进行操作，或采用双导管法（2C）。排除行冠状动脉旁路移植术或心室造影的操作。成功完成了387例桡动脉操作。其中194例采用2C法，193例采用JLC。评估无法使用预期导管的情况、总透视时间（分钟）、造影剂用量（毫升）、桡动脉痉挛（RAS）的发生情况以及桡动脉闭塞（RAO）情况。
在2C组中，191例患者（98.9%）的右冠状动脉（RCA）和192例患者（99.4%）的左冠状动脉（LCA）造影成功。在JLC组中，分别有193例（99.4%）和174例（89.6%）患者的RCA和LCA造影成功。JLC组补充导管的使用率（21例；10.8%）显著高于2C组（3例；1.5%，P = 0.001）。JLC组的平均透视时间较短（2.0±2.3分钟对2.3±1.5分钟；P = 0.043）。使用JLC时平均操作时间也有所缩短，但未达到统计学意义（5.7±3.1分钟对6.2±2.5分钟；P = 0.081）。若不考虑JLC塑形的额外时间，JLC组的平均操作时间显著缩短（5.6±2.9分钟对6.2±2.4分钟；P = 0.031）。2C组造影剂用量有降低趋势（49±13毫升对52±18毫升；P = 0.061）。2C组RAS的发生率更高（11.3%对21.7%，P = 0.005）。2C组RAO的发生率有升高趋势（4.1%对8.3%，P = 0.064）。
在经RRA的桡动脉操作中，当没有专用两用导管时，JLC导管可能非常有效。
