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Single Catheter Use as the Default Approach for Coronary Angiography and Intervention in Patients with ST-Elevation
Yusuf Can1, Ömer Faruk Erkan2, Muhammet Taşdemir3
1Department of Cardiology, Faculty of Medicine, Sakarya University, Adapazari 54188, Turkey.
Insights
Using a single Judkins Left 3.5 catheter for transradial access in ST-elevation myocardial infarction (STEMI) procedures is feasible and safe. This approach reduces contrast, procedure time, radiation exposure, and complications compared to multi-catheter techniques.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Transradial access (TRA) is standard for ST-elevation myocardial infarction (STEMI).
- Limited evidence exists for single-catheter use in diagnostic angiography and percutaneous coronary intervention (PCI).
Purpose of the Study:
- Evaluate the feasibility and clinical outcomes of a single Judkins Left (JL) 3.5 guiding catheter via TRA in STEMI patients.
- Assess procedural success rates and identify advantages over multi-catheter approaches.
Main Methods:
- 1139 patients undergoing radial access PCI with a single JL 3.5 catheter were analyzed.
- Procedural success defined as completing angiography and PCI without catheter exchange.
- Procedural characteristics and access-site complications were systematically evaluated.
Main Results:
- A 91.1% success rate was achieved using a single JL 3.5 catheter.
- The single-catheter group showed significantly lower contrast volume, procedure time, fluoroscopy time, radiation dose, and needle-to-balloon time (p < 0.001).
- Access-site complications, particularly radial artery spasm, were significantly reduced (8.2% vs. 15.8%, p = 0.010).
Conclusions:
- A single JL 3.5 catheter strategy via TRA is safe, efficient, and effective for STEMI intervention.
- This approach offers significant procedural and clinical advantages, including reduced complications.
- Supports the adoption of single-catheter techniques in radial STEMI interventions.
Abstract:
Background/Objectives: Transradial access (TRA) is a standard approach in the management of ST-segment elevation myocardial infarction (STEMI); however, evidence on using a single catheter for both diagnostic angiography and percutaneous coronary intervention (PCI) is limited. This study evaluates the feasibility and clinical outcomes of using a single Judkins Left (JL) 3.5 guiding catheter via TRA in STEMI patients. Methods: A total of 1139 patients undergoing radial access PCI with a single JL 3.5 catheter were included. Procedural success was defined as completing both diagnostic coronary angiography and PCI without catheter exchange. Procedural characteristics and access-site complications were evaluated. Results: The success rate of completing diagnostic angiography and PCI using a single JL 3.5 guiding catheter without catheter exchange was 91.1%. Compared to procedures requiring multiple catheters, the single-catheter group had significantly lower total contrast volume (200 vs. 250 mL), procedure time (20 vs. 30 min), fluoroscopy time (10.3 vs. 17.6 min), radiation dose (358 vs. 545 mGy), and needle-to-balloon time (6 vs. 9 min), all with p < 0.001. Access-site complications were also lower (8.2% vs. 15.8%; p = 0.010), primarily due to reduced radial artery spasm (4.0% vs. 12.9%; p = 0.001). Conclusions: A single JL 3.5 catheter strategy via transradial access is a safe, efficient, and effective method for STEMI intervention, offering significant procedural and clinical advantages.
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