Histologic evidence of angiographic catheter-induced vascular trauma: a comparison of conventional and deformable soft-tip catheters
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Published on: July 9, 2020
R A Van Tassel1, F L Gobel, D J MacCarter
1Minneapolis Heart Institute, Minneapolis, Minnesota, USA.
Insights
Soft-tip angiographic catheters significantly reduce vascular trauma compared to conventional types. This study in canine arteries shows an 86% reduction in lesions, offering a safer approach for cardiology procedures.
Area of Science:
- Cardiovascular Research
- Medical Device Technology
- Histopathology
Background:
- Catheter-related complications, including vascular trauma, are significant risks during coronary arteriography and percutaneous transluminal coronary angioplasty (PTCA).
- These complications may stem from catheter-tip-induced injury to blood vessels.
- Development of deformable, soft-tip angiographic catheters aims to mitigate these risks.
Purpose of the Study:
- To evaluate and compare the vascular effects of a deformable soft-tip angiographic catheter versus conventional catheters.
- To assess the incidence and severity of arterial lesions induced by different catheter types in a canine model.
Main Methods:
- Ten dogs were catheterized using either a conventional or a soft-tip (Angiomedics SOFTIP) Judkins left 3.5 catheter.
- Repeated catheterization was performed on the left coronary artery, aorta, and right iliac artery.
- Histologic analysis of 45 arterial tissue sections was conducted 2 weeks post-catheterization.
Main Results:
- Soft-tip catheters resulted in an 86% reduction in subintimal lesions in muscular arteries (LCA, iliac) compared to conventional catheters (p <.017).
- Conventional catheters caused two medial tears, while soft-tip catheters did not.
- The average severity of muscular arterial lesions was significantly lower with soft-tip catheters (1.0) than conventional ones (2.0, p <.02).
Conclusions:
- Conventional angiographic catheters induce more frequent and severe subacute, subintimal vascular lesions than soft-tip catheters.
- Soft-tip catheters demonstrate a significantly safer and less traumatic approach for diagnostic and interventional cardiology.
- These findings support the use of soft-tip catheters to minimize iatrogenic vascular injury.
Abstract:
Catheter-related complications associated with coronary arteriography remain an iatrogenic hazard with life-threatening consequences. Because such complications may be related to catheter-tip-induced vascular trauma during coronary angiography or percutaneous transluminal coronary angioplasty (PTCA), several types of deformable, soft-tip angiographic catheters have been developed. The following study was undertaken to evaluate the effects of one of these catheters, as well as of conventional catheters, in canine arteries. Ten dogs were catheterized, five with a conventional angiographic catheter and five with a deformable soft-tip catheter (Angiomedics SOFTIP model), all in the Judkins left 3.5 configuration. The left coronary artery (LCA) was subjected to repeated catheterization; the instruments were also advanced and withdrawn through various segments of the thoracic and abdominal aorta and the right iliac artery. Forty-five arterial tissue sections were collected; these were subjected to histologic analysis 2 weeks after catheterization. When catheterized with the soft-tip instrument, muscular arteries such as the LCA and the right iliac artery had an 86% reduction in subintimal lesions with a disrupted or split internal elastic membrane, compared to muscular arteries catheterized with a conventional instrument (p <.017). Moreover, two medial tears were produced by the conventional catheters. On a scale of 1 to 3 (3 being the most severe), the average severity of muscular arterial lesions observed after use of the soft-tip catheter was 1.0, whereas the average severity associated with conventional catheters was 2.0 (p <.02). No significant differences were observed in elastic (aortic) segments. Therefore, this study showed that subacute, subintimal vascular lesions induced by conventional angiographic catheters are more frequent, more serious, and more likely to penetrate the internal elastic membrane than are lesions produced by soft-tip catheters. Obviously, then, soft-tip catheters offer a safer, less traumatic approach to diagnostic and interventional cardiology.
