Langer Christoph, Riehle Julia, Wuttig Helge, Dürrwald Stephanie, Lange Helmut, Samol Alexander, Frey Norbert, Wiemer Marcus
Klinik für Innere Medizin III mit den Schwerpunkten Kardiologie, Angiologie und internistische Intensivmedizin Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Germany.
Kardiologische-Angiologische Praxis-Herzzentrum Bremen, Bremen, Germany.
PLoS One. 2018 Jan 2;13(1):e0189899. doi: 10.1371/journal.pone.0189899. eCollection 2018.
Transradial coronary angiography (TRC) can be performed with a one-catheter approach for the right and left coronary ostium (R/LCO). We investigated the performance of a special diagnostic catheter widely used for the one-catheter-approach, the Tiger (Tiger II, TerumoTM).
In a dual center registry we analyzed 1412 TRC-procedures exclusively performed by experienced TRC-operators. We compared the performance of the Tiger with Judkins catheters by retrospectively judging ostial catheter stability during contrast injection, and by measuring contrast use, fluoroscopy time (FT) and complication rate.
Poor or failed ostial engagement was found in 40.5% in the Tiger group, compared to 46.6% with the use of Judkins catheters (p<0.183). Ostial instability of the Tiger was found more often during engagement of the LCO than the RCO (34.4% vs. 10.8%, p<0.001), whereas it was similar in the LCO and RCO for Judkins catheters (27.4% vs. 26.7%, p = 0.840). TRC-procedures performed with Tiger catheters were associated with less contrast volume (63.48 ± 29.83mL vs. 82.51 ± 56.58mL, p<0.004) and shorter FT than with Judkins catheters. (198.27 ± 194.8sec vs. 326.85 ± 329.70sec). Forearm hematomas occurred less often with the Tiger (1.2% vs. 6.6%, p< 0.02).
The Tiger employed as a single catheter in TRC is an effective tool to achieve lower contrast volume and fluoroscopy time at a low complication rate. Unstable engagement affects predominantly the left coronary artery, but its overall frequency is similar for both, the Tiger and Judkins catheters.
经桡动脉冠状动脉造影（TRC）可通过单导管方法对左右冠状动脉开口（R/LCO）进行操作。我们研究了一种广泛用于单导管方法的特殊诊断导管——虎牌导管（虎牌二代，泰尔茂TM）的性能。
在一个双中心注册研究中，我们分析了由经验丰富的TRC操作者专门进行的1412例TRC手术。我们通过回顾性判断造影剂注射期间开口处导管的稳定性、测量造影剂用量、透视时间（FT）和并发症发生率，比较了虎牌导管与Judkins导管的性能。
虎牌导管组开口处插管不良或失败率为40.5%，而使用Judkins导管时为46.6%（p<0.183）。在左冠状动脉开口插管时，虎牌导管开口处不稳定的情况比右冠状动脉开口处更常见（34.4%对10.8%，p<0.001），而Judkins导管在左冠状动脉开口和右冠状动脉开口处的情况相似（27.4%对26.7%，p = 0.840）。与Judkins导管相比，使用虎牌导管进行的TRC手术造影剂用量更少（63.48±29.83mL对82.51±56.58mL，p<0.004），透视时间更短（198.27±194.8秒对326.85±329.70秒）。使用虎牌导管时前臂血肿的发生率较低（1.2%对6.6%，p<0.02）。
在TRC中作为单导管使用的虎牌导管是一种有效的工具，可在低并发症发生率的情况下实现更低的造影剂用量和透视时间。不稳定的插管主要影响左冠状动脉，但虎牌导管和Judkins导管的总体频率相似。
