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Published on: July 12, 2024
Judkins left catheter size selection during right trans-radial coronary angiography using preprocedural coronary
Abdulameer Jasim Jawad Al-Gburi1
1Department of Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq.
Insights
Choosing the right catheter for coronary angiography is key. Ascending aorta size, measured by CT scan, predicts the need for larger catheters, improving procedural success.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Radiology
Background:
- Proper catheter selection in right trans-radial coronary angiography is crucial for reducing procedure time, costs, and vascular complications.
- Aortic morphology may influence the choice of catheter size, but this relationship requires further investigation.
Purpose of the Study:
- To investigate the correlation between aortic morphological parameters, assessed via computed tomography (CT), and the requirement for larger catheter sizes during right trans-radial coronary angiography.
Main Methods:
- An observational study involving 206 patients who underwent right trans-radial coronary angiography and prior coronary CT angiography.
- Patients were divided into two groups: those who successfully used a Judkins left (JL) 3.5 catheter and those requiring a JL 4 or larger catheter.
- Aortic CT images were analyzed for four morphological variables, including ascending aorta maximal area and length.
Main Results:
- Significant differences in ascending aorta maximal area and length were observed between the groups.
- Ascending aorta maximal area (OR 31.82) and length (OR 29.97) were strong predictors for needing a JL 4 or larger catheter.
- An ascending aorta maximal area cutoff of 12.25 cm² (derived diameter 3.94 cm) demonstrated high sensitivity (94.9%) and specificity (95.2%).
Conclusions:
- Maximal area and length of the ascending aorta are significant predictors for selecting the appropriate catheter size in right trans-radial coronary angiography.
- Utilizing CT-derived aortic measurements can aid in optimizing catheter selection, potentially improving procedural outcomes.
Objectives:
Proper catheter selection during right trans-radial coronary angiography reduces procedure duration, costs, and vascular complications. The correlation between aorta morphological parameters assessed through computed tomography (CT) and requirement for larger catheter size was investigated in this study.
Materials And Methods:
This observational study includes 206 patients who underwent right trans-radial coronary angiography and had already undergone coronary CT angiography at a recognized center from April 2023 to January 2025. Patients who completed angiography using a Judkins left (JL) 3.5 (Group 1) catheter were compared with patients who required catheter exchange with a JL 4 or larger (Group 2). Both groups had their CT images analyzed for four specific aortic morphological variables.
Results:
A total of 167 patients formed Group 1, whereas 39 patients formed Group 2. The significant differences were detected in the maximal area and length of the ascending aorta among the four aortic CT variables. In multivariable logistic regression model, the strongest association with the need for JL4 or more catheter (Group 2) was found with the maximal area of the ascending aorta (odds ratio [OR] 31.82 [(95% confidence interval [CI]) 1.21-831.18], P < 0.001) followed by length of the ascending aorta (OR 29.97 [(95% CI) 1.06-845.08], P < 0.001). An ascending aorta maximal area cutoff value was 12.25 cm2 (SN 94.9%, SP 95.2%) with the derived diameter of 3.94 cm.
Conclusion:
Maximum area (with derived diameter) and ascending aortic length were the good predictors for suitable catheter selection during right trans-radial invasive coronary angiography.
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