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Appropriate Selection of the Initial Diagnostic Catheter for Left Coronary Angiography Using Computed Tomography
Tatsuhiro Fujimura1, Masaki Takemitsu2, Reina Murayama2
1Division of Cardiology, Department of Medicine and Clinical Science, Graduate School of Medicine, Yamaguchi University, Ube, JPN.
Insights
For left coronary angiography, a larger catheter like Judkins left 5.0 (JL5) may be needed in patients with an ascending aorta diameter over 38 mm. This finding optimizes catheter selection for dilated aortas.
Area of Science:
- Cardiovascular Imaging and Intervention
- Interventional Cardiology
Background:
- Engaging the left coronary artery during left coronary angiography (CAG) can be challenging in patients with a dilated ascending aorta.
- A diagnostic catheter with a larger curve than the Judkins left 4.0 (JL4) is sometimes necessary, but optimal selection criteria are not well-defined.
Purpose of the Study:
- To investigate the relationship between aortic morphological parameters and the requirement for a larger catheter (Judkins left 5.0, JL5) during left CAG.
Main Methods:
- Patients undergoing CAG and contrast-enhanced computed tomography (CT) were divided into JL4 and JL5 groups.
- Nine aortic morphological parameters were measured from CT images and compared between groups.
Main Results:
- The JL5 group (19 patients) showed significantly larger maximum ascending aorta area and length, total aortic length, and aortic width/depth compared to the JL4 group (230 patients).
- Maximum ascending aorta area was the strongest predictor for needing JL5 (odds ratio 1.71 per 100 mm²).
- A cutoff area of 1111.2 mm² (approx. 38 mm diameter) predicted JL5 use.
Conclusions:
- An ascending aorta diameter exceeding 38 mm on CT may indicate the need for a larger curve catheter like JL5 for initial engagement of the left coronary artery.
- This finding can help optimize catheter selection and potentially improve left CAG procedure efficiency.
Purpose:
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).
Methods:
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.
Results:
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 mm2, 1.71 (1.33-2.21), p < 0.0001). The cutoff value for the maximum area of the ascending aorta was 1111.2 mm2 (corresponding to an ascending aortic diameter of approximately 38 mm).
Conclusion:
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.
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