Related Experiment Videos
Coronary angiography with 5 French diagnostic catheters may miss an ostial left main stenosis
1Maimonides Medical Center, Division of Cardiology, SUNY Health Science Center, Brooklyn, NY 11219.
Insights
Diagnosing critical left main disease is vital. Smaller 5 French catheters used in outpatient cardiac catheterization may miss ostial left main stenosis, which larger 8 French catheters can visualize.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Critical ostial left main disease diagnosis is crucial to prevent sudden death.
- Increasing outpatient cardiac catheterization pressures necessitate early patient ambulation.
- Smaller French catheters (5F) are preferred for early ambulation, replacing larger ones (7F).
Observation:
- A patient with suspected ostial left main stenosis underwent coronary arteriography.
- A diagnostic 5 French catheter was used, allowing easy selective intubation of the left main coronary artery without pressure damping.
- Coronary angiography with the 5 French catheter did not reveal the ostial stenosis, showing normal contrast reflux.
Findings:
- The ostial left main stenosis was not visualized with the 5 French diagnostic catheter.
- A subsequent guiding angiogram using an 8 French catheter clearly demonstrated the ostial stenosis.
- This highlights a potential limitation of smaller catheters in diagnosing specific coronary artery lesions.
Implications:
- Smaller diagnostic catheters may lead to underdiagnosis of critical ostial left main stenosis.
- Larger catheters may be necessary for accurate visualization of certain coronary artery lesions.
- This finding has implications for diagnostic strategies in outpatient cardiac catheterization settings.
Abstract:
Critical ostial left main disease may lead rapidly to sudden death and is, therefore, of paramount importance to diagnose. While the number of cardiac catheterizations is increasing, government and third party reimbursement sources are imposing pressure to perform more studies in an outpatient setting, as the economic resources for medical procedures are shrinking. Outpatient cardiac catheterization requires the patient to ambulate within several hours after the procedure. In order to allow patients to safely ambulate early after their procedures, 5 French catheters are often used (whether the femoral or brachial approach is used) rather than the standard 7 French catheters. We describe a patient with an ostial left main stenosis that was not visualized when coronary arteriography was performed using a diagnostic 5 French catheter. Selective intubation of the left main coronary artery was easily achieved without damping of the pressure tracing. Selective coronary angiography did not demonstrate the ostial stenosis, and there appeared to be a normal amount of contrast refluxing into the aortic root. When the patient returned for an angioplasty and a guiding angiogram was performed with an 8 French catheter, an ostial stenosis was evident with coronary angiography.