Department of Cardiology, University Hospital Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, University of Lleida, Lleida, Spain.
Arch Cardiol Mex. 2020;90(4):442-451. doi: 10.24875/ACM.19000352.
One-catheter strategy, based in multipurpose catheters, allows exploring both coronary arteries with a single catheter. This strategy could simplify coronary catheterization and reduce the volume of contrast administration, by reducing radial spasm. To date, observational studies showed greater benefits regarding contrast consumption and catheterization performance than controlled trials. The aim of this work is to perform the first systematic review and meta-analysis of randomized clinical trials (RCT) to adequately quantify the benefits of one-catheter strategy, with multipurpose catheters, over conventional two-catheter strategy on contrast consumption, and catheterization performance.
A search in PubMed, CINALH, and CENTRAL databases was conducted to identify randomized trials comparing one-catheter and two-catheter strategies. The primary outcome was volume of iodinated contrast administrated. Secondary endpoints, evaluating coronary catheterization performance included: arterial spasm, fluoroscopy time, and procedural time.
Five RCT were included for the final analysis, with a total of 1599 patients (802 patients with one-catheter strategy and 797 patients with two-catheter strategy). One-catheter strategy required less administration of radiological contrast (difference in means [DiM] [95% confidence interval (CI)]; -3.831 mL [-6.165 mL to -1.496 mL], p = 0.001) as compared to two-catheter strategy. Furthermore, less radial spasm (odds ratio [95% CI], 0.484 [0.363 to 0.644], p < 0.001) and less procedural time (DiM [95% CI], -72.471 s [-99.694 s to -45.249 s], p < 0.001) were observed in one-catheter strategy. No differences on fluoroscopy time were observed.
One-catheter strategy induces a minimal reduction on radiological contrast administration but improves coronary catheterization performance by reducing arterial spasm and procedural time as compared to conventional two-catheter strategy.
基于多用途导管的单导管策略允许使用单个导管同时探查两支冠状动脉。这种策略可以通过减少桡动脉痉挛来简化冠状动脉造影术并减少造影剂的使用量。迄今为止，观察性研究显示与对照试验相比，在造影剂消耗和导管性能方面具有更大的益处。本研究旨在对随机临床试验（RCT）进行首次系统评价和荟萃分析，以充分量化多用途导管单导管策略相对于传统双导管策略在造影剂消耗和导管性能方面的优势。
在 PubMed、CINALH 和 CENTRAL 数据库中进行检索，以确定比较单导管和双导管策略的随机试验。主要结局是碘造影剂的用量。评估冠状动脉导管性能的次要终点包括：动脉痉挛、透视时间和手术时间。
最终纳入 5 项 RCT 进行分析，共纳入 1599 例患者（单导管策略组 802 例，双导管策略组 797 例）。与双导管策略相比，单导管策略需要更少的放射造影剂（均数差值[DiM] [95%置信区间（CI）]；-3.831 mL [-6.165 mL 至-1.496 mL]，p = 0.001）。此外，单导管策略组桡动脉痉挛（比值比[95%CI]，0.484 [0.363 至 0.644]，p < 0.001）和手术时间（DiM [95%CI]，-72.471 s [-99.694 s 至-45.249 s]，p < 0.001）更少。透视时间无差异。
与传统的双导管策略相比，单导管策略可使放射造影剂的使用量略有减少，但通过减少动脉痉挛和手术时间来改善冠状动脉造影术的性能。
