Performance of single reshaped Judkins left catheter for transradial coronary angiography

doi:10.4236/wjcd.2013.39091

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World Journal of Cardiovascular Diseases, 2013, 3, 581-584 WJCD

http://dx.doi.org/10.4236/wjcd.2013.39091 Published Online December 2013 (http://www.scirp.org/journal/wjcd/)

Performance of single reshaped Judkins left catheter for

transradial coronary angiography

Guangming Zhang, Wei Cui*, Ruiqin Xie, Fan Liu, Guoqiang Gu, Jingchao Lu, Hongmei Zheng,

Xiuchun Yang, Xiaohong Yang

Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China

Email: *[email protected]

Received 21 September 2013; revised 25 October 2013; accepted 8 November 2013

cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: To investigate the feasibility of single

reshaped Judkins left catheter for transradial coro-

nary angiography. Methods: A total of 198 consecu-

tive patients were enrolled in the first step study. Pa-

tients were randomly assigned to brachial type cathe-

ter group (BRACT group) or Judkins left catheter

group (Judkins group). The inclusion criterion was

the left coronary angiography which could be accom-

plished by either a brachial type catheter or a reshap-

ed Judkins left catheter. The successful procedure

was defined as both right and left coronary angiogra-

phy could be completed with a single reshaped Jud-

kins left catheter or a brachial type catheter. Further-

more, 1873 consecutive patients were continuously

enrolled to observe the success rate of single Judkins

left catheter for transradial coronary angiography.

Results: Of the 198 patients, 191 were finally enrolled

in this study according to the inclusion criteria, with

95 patients in BRACT group and 96 in Judkins group.

There were no significant differences on baseline be-

tween the two groups. Procedure success rate was

84.10% with a fluoroscopic exposure time of 3.81 ±

0.43 min in BRA-CT group, and 81.60% with a fluo-

roscopic exposure time of 4.05 ± 0.48 min in Judkins

group (P > 0.05). No severe complications were found

in either of the two groups. The success rates of 1869

patients with single Judkins left catheter for transra-

dial coronary angiography were 75.33%. There were

no complications in tho se patien t s. C o nc lu si o ns : Tr an -

sradial coronary angiography with a reshaped single

Judkins left catheter is feasible and practical, with an

accepted procedure success rate. This method should

be worthy of further clinical validation in a larger

scale population.

Keywords: Coronary Angiography; Transradial; Judkins

Left Catheter

1. INTRODUCTION

Transradial coronary percutaneous procedures are asso-

ciated with reduced entry site complications compared to

transfemoral [1], and transradial procedures are beco-

ming widely accepted by operators and patients because

of the patients resuming activity immediately after the

procedure and avoiding the discomfort of forced, pro-

longed bed rest. But one of the drawbacks for transradial

procedures is related to the possibility of radial artery

damage, which is mostly related to the insertio n of over-

sized sheaths, but possibly also to catheter exchange [2].

Potential consequences of arterial injury are spasm and

radial artery occlusion.

The purpose of this study was to evaluate the feasi-

bility of single reshaped Judkins left catheter for enga-

ging both coronary arteries via the right transradial artery

approach, compared with conventional brachial type

catheter BRACT.

2. METHODS

2.1. Patient Selection

From January to December 2006, A total of 198 inpa-

tients undergoing transradial diagnostic coronary angio-

graphy or elective percutaneous coronary intervention

were consecutively enrolled in the first step study. Pa-

tients were randomly assigned to Judkins left catheter

group (Judkins group) or brachial type catheter BRACT

group (BRACT group). The inclusion criterion was pa-

tients with a positive Allen test, and only th ose in whom

the left coronary angiography could be accomplished

with either a BRACT catheter or a reshaped Judkins left

catheter were analyzed.

*Corresponding a uthor.

OPEN ACCESS

G. M. Zhang et al. / World Journal of Cardiovascular Diseases 3 (2013) 581-584

582

In addition, from January 2006 to April 2012, included

198 inpatients in above analysis, 1873 inpatients under-

going transradial diagnostic coronary angiography or

elective percutaneous coronary intervention were con-

secutively enrolled. All of them were underoperated with

single Judkins left catheter for transradial coronary an-

giography. All patients provided written, informed con-

sent before catheteri zat i on .

2.2. Judkins Left Catheter Reshaped

Before the Judkins left catheter was used for coronary

angiography, the secondary curve of the regular catheter

was reshaped to a right angle by forcefully sliding the

catheter through fingers in order to obtain a configu-

ration similar to the brachial type catheter (Figure 1).

2.3. Catheterization Procedures

Transradial angiography was performed just as the usual

right radial approach. The radial artery was punctured

with a radial artery needle, and a 0.025’’ guidewire was

inserted through the needle. A 12-cm-long 6F radial

sheath was then inserted. Heparin was given as a bolus

intravenous infusion with a dose of 3000 - 5000 IU. The

sheath was removed immediately after the procedure.

Hemostasis was achieved by radial compression with an

artery compression bandage.

Diagnostic catheters used were either reshaped Jud-

kins Left catheter (MERIT MEDICAL, USA) or the BR-

ACT (MERIT MEDICAL, USA). The selection of diag-

nostic catheter was randomized. Judkins left 3.5 catheters

were usually used, but Judkins left 4.0 catheter was also

selected when ascending aorta was overwrite. When re-

shaped Judkins left catheters were used, after the left

coronary angiography was done, the reshaped Judkins

left catheter was rotated clockwise 90˚ - 180˚ under fluo-

roscopy guidance using a LAO projection, and this ma-

neuver usually made the catheter engage the right coro-

nary artery easily. The skill for th e BRACT catheter was

the similar to that described above.

JL JL r es haped BRACT

(a) (b) (c)

Figure 1. Show the original JL (a) is reshaped (b) to a configu-

ration similar to BRACT catheter (c).

2.4. Observations and Definitions

Procedure success rate: the successful angiographic pro-

cedures were recorded in Judkins group or BRACT

group. The successful procedure was defined as both

right and left coronary angiography could be completed

with a single reshaped Judkins left catheter or a BRACT

catheter. Total fluoroscopic time: four to five conven-

tional projections were used for left coronary angiogra-

phy, and two for right coronary angiography. The total

fluoroscopic time was recorded in every patient during

transradial angiographic procedures. Complications: We

observed the patients until 3rd day after the procedure,

procedure-related complications were observed, inclu-

ding the need for surgical correction of vascular access

site, permanent neurological deficit, radial artery occlu-

sion, and peri-procedural Q-wave or non Q-wave myo-

cardial infarction or death.

2.5. Statistical Analysis

All data were prospectively recorded on standardized

forms. Data are presented as mean  standard deviation

for continuous variables and as the percentage for cate-

gorical variables. Continuous variables were analyzed by

an independent-samples t-test. Categorical varia bles

were compared by x2 analysis. Statistical analysis was

performed with the SPSS, version 11.5, software pack-

age (SPSS, Chicago, IL). A P-value < 0.05 was consi-

dered statistically significant.

3. RESULTS

3.1. Baseline Data

Of the 198 patients, 191 patients were eligible for the

study, including 95 patients in BRACT group and 96 in

Judkins group. The JL3.5 catheter was used in 86 patients

and JL4.0 in 10 cases in Judkins group. The mean patient

age was 56.84 ± 9.50 years, with 28.3% females. The

patients in the Judkins group and BRACT group were

well matched for age, sex, and other demographic data

(Table 1).

Of the 1873 patients, 1869 patients were used with

single reshaped Judkins left catheter for transradial coro-

nary angiography, the mean age was 57.99 ± 4.84 years,

27.3% were female. All of the patients had stable hemo-

dynamics and good radial artery pulses (positive Allen

test). The study wer e not include of the other approach if

the radial artery approach failed.

3.2. Procedural Characteristics between Two

Groups

In the Judkins group, 78 of 96 patients were completed

the procedure successfully with a single reshaped Jud-

kins left catheter, with a procedure success rate of

G. M. Zhang et al. / World Journal of Cardiovascular Diseases 3 (2013) 581-584 583

81.25%. While 80 of 95 patients were completed the

procedure with a BRACT catheter, yielding a procedure

success rate of 84.21%. The procedure success rate in the

Judkins group showed no significant difference com-

pared with that in the BRACT group (P = 0.70) (Table

2).

Total fluoroscopic time was 4.28 ± 0.48 min in Jud-

kins group, and 4.21 ± 0.43 min in BRACT grou p. There

were no significant difference in total fluoroscopic time

between the two groups (P = 0.29) (Table 2).

No significantly statistical differences between the

groups regarding to radial artery spasm and angiographic

or clinical complications (Table 2).

3.3. Success Rates of Single Reshaped Judkins

Left Catheter

Of the 1873 patients, 1869 patients were eligible for the

study. Overall, 1408 cases (75.33%) were performed

both left and right coronary angiography with only one

reshaped Judkins left catheter, and 459 cases (24.56%)

were performed with two catheters because the Judkins

left catheter couldn’t reach to right coronary artery

Table 1. Baseline patient’s characteristics.

Judkins group

(n = 96) BRACT group

(n = 95) P-values

Age (years) 56.0 ± 9.9 57.1 ± 8.9 0.17

Male gender (n (%)) 68 (70.8) 73 (76.8) 0.06

Hemoglobin (g/l) 130.1 ± 11.2 135.3 ± 12.6 0.16

BMI (kg/m2) 25.3 ± 3.59 25.7 ± 3.10 0.08

Risk factors (n (%))

Hypertension 64 (66.7) 66 (69.5) 0.36

Hyperlipidemia 29 (30.2) 33 (34.7) 0.26

Diabetes mellitus 20 (20.8) 22 (23.2) 0.33

Smoking 52 (54.2) 52 (54.7) 0.97

Values are expressed as mean ± SD or n (%). P-values derived from inde-

pendent sample t-test for continuous variables or x2 test for categorical

variables. BMI: body mass index.

Table 2. Safety and efficacy between Judkins group and BRA-

CT group.

Judkins group

(n = 96) BRACT group

(n = 95) P values

Success rates (n (%)) 78 (81.25) 80 (84.21) 0.70

Fluoroscopic time (min) 4.28 ± 0.48 4.21 ± 0.43 0.29

Complications (n (%)) 0 (0) 0 (0) 1.00

Values are expressed as mean ± SD or n (%). P-values derived from inde-

pendent sample t-test for continuous variables or x2 test for categorical

variables.

ostium. The other 2 cases had abnormal right coronary

artery ostium that the Judkins right catheter couldn’t

reach to right coronary artery ostium, so we had to use

the Amplatz Right (AR) catheter to reach to right coro-

nary artery ostium.

4. DISCUSSION

In recent years, the transradial approach has been used

increasingly as an alternative to femoral approach for

percutaneous coronary diagnosis and intervention. Most

of the diagnostic catheters that are currently used for

transradial coronary angiography are the Judkins, Am-

platz, which have curves originally designed for a fe-

moral approach. The technical and anatomic aspects of

transradial access are different from those of femoral

access, thus making manipulation of conventional diag-

nostic catheters sometimes difficult an d time-consuming.

Therefore, many attempts have been made to design a

catheter for a transradial approach for routine diagnostic

and interventional coronary procedures, trying to engage

both coronary arteries by one single catheter [3]. For

example, the 5F Tiger II (Terumo Corporation, Tokyo,

Japan) catheters were tested to prove the feasibility,

safety, and performance as a kind of multipurpose

catheter for transradial coronary angiography [4]. The

Brachial Type K (Terumo Outlook, Leuven, Belgium)

catheters were also proved to to perform both left and

right coronary angiography with a single catheter [5].

The diagnostic catheter that currently used for tran-

sradial coronary angiography in most hospitals in China

is the multipurpose brachial type catheter (BRACT).

BRACT catheter is more costly than Judkins, which

limits the useage of BRACT catheter to some extent.

This study demonstrated the feasibility and safety of

single reshaped Judkins left catheter for engaging both

coronary arteries via the right transradial artery ap-

proach.

The present study showed that by using a reshaped

Judkins left catheter, it was possible to successfully per-

form both left and right coronary angiography in 75.33%

of the cases, which was very similar to conventional

radial catheter with respect to procedure success rate and

fluoroscopic time. Moreover, there were no instances of

aortic or coronary dissection. The manipulation of diag-

nostic catheters also did not lead to excessive spasm.

According to our experien ce, the 5F Judkins left catheter

was more suitable for reshaping, although the 6F catheter

can also be reshaped. Another advantage by using a

reshaped Judkins left catheter was that this reshaped

catheter didn’t need a guidewire support for engaging

either the right or the left coronary arteries, even when

the initial attempt for engaging failed. This will simplify

the manipulation and reduce the potential complications

related to guidewire exchange.

G. M. Zhang et al. / World Journal of Cardiovascular Diseases 3 (2013) 581-584

584

5. STUDY LIMITATIONS

OPEN ACCESS

This study is limited by its small sample size. Otherwise,

we didn’t compare reshaped left Judkins catheter with

other catheter designs, including non-reshaped left Jud-

kins catheters, and await confirmation by prospective

analyses.

6. CONCLUSION

Transradial coronary angiography with a reshaped single

Judkins left catheter is feasible and practical, with an

accepted procedure success rate. This method should be

worthy of further clinical validation in a lager scale

population.

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