Fujimura Tatsuhiro, Takemitsu Masaki, Murayama Reina, Nishimura Taisei, Miyazaki Yosuke, Matsuyama Tetsuya, Nakata Yuki, Okamura Takayuki, Sano Motoaki
Division of Cardiology, Department of Medicine and Clinical Science, Graduate School of Medicine, Yamaguchi University, Ube, JPN.
Department of Radiological Technology, Yamaguchi University Hospital, Ube, JPN.
Cureus. 2024 Dec 2;16(12):e75004. doi: 10.7759/cureus.75004. eCollection 2024 Dec.
In patients with a dilated ascending aorta, a diagnostic catheter with a larger curve than the Judkins left 4.0 (JL4) is occasionally required to engage the left coronary artery. However, the specific size of the ascending aorta and other parameters have not been sufficiently investigated. We examined the relationship between aortic morphological parameters and the need for a larger catheter size during left coronary angiography (CAG).
At our hospital, consecutive patients who underwent both CAG and contrast-enhanced computed tomography (CT) for aorta and coronary imaging were divided into two groups based on the catheter used for left CAG: the JL4 group and the Judkins left 5.0 (JL5) group. Nine selected aortic morphological parameters from the CT images were measured and compared between the two groups.
The JL5 and JL4 groups included 19 and 230 patients, respectively. The JL5 group had higher numbers of coronary diagnostic catheters used, longer procedure times, and greater contrast volumes compared to the JL4 group. Among the nine aortic morphological parameters, significant differences were found in the maximum area and length of the ascending aorta, the total length of the aorta, and the width and depth of the aorta. Multivariate analysis revealed that the maximum area of the ascending aorta was most strongly associated with the need for JL5 in left CAG (odds ratio (95% CI) per 100 mm, 1.71 (1.33-2.21), p < 0.0001). The cutoff value for the maximum area of the ascending aorta was 1111.2 mm (corresponding to an ascending aortic diameter of approximately 38 mm).
Selecting a large-curve diagnostic catheter, such as the JL5, as the initial diagnostic catheter for engaging the left coronary artery in patients with an ascending aorta diameter greater than 38 mm on CT may optimize left CAG.
对于升主动脉扩张的患者，有时需要使用比Judkins左4.0（JL4）弯曲度更大的诊断导管来进入左冠状动脉。然而，升主动脉的具体尺寸及其他参数尚未得到充分研究。我们研究了主动脉形态学参数与左冠状动脉造影（CAG）时使用更大尺寸导管的必要性之间的关系。
在我院，对因主动脉和冠状动脉成像同时接受CAG和对比增强计算机断层扫描（CT）的连续患者，根据左CAG所用导管分为两组：JL4组和Judkins左5.0（JL5）组。从CT图像中测量9个选定的主动脉形态学参数，并在两组之间进行比较。
JL5组和JL4组分别包括19例和230例患者。与JL4组相比，JL5组使用的冠状动脉诊断导管数量更多、手术时间更长、造影剂用量更大。在9个主动脉形态学参数中，升主动脉的最大面积和长度、主动脉总长度以及主动脉的宽度和深度存在显著差异。多因素分析显示，升主动脉的最大面积与左CAG中使用JL5的必要性关联最为密切（每100 mm的优势比（95%可信区间）为1.71（1.33 - 2.21），p < 0.0001）。升主动脉最大面积的截断值为1111.2 mm（对应升主动脉直径约为38 mm）。
对于CT显示升主动脉直径大于38 mm的患者，选择大弯曲度的诊断导管，如JL5，作为进入左冠状动脉的初始诊断导管，可能会优化左CAG。
