Are you dyed‐in‐the‐wool?

Abstract

Are you a six, seven, or (heaven forbid) an eight user? If so, read on.The contribution by Khoukaz et al.[1] describes a study of using small-and smaller-size catheters for coronary angiography. A mechanical injector is used for the smaller catheters.Is smaller better? Yes, smaller is better because patient comfort is greater at sheath insertion. Coronary dissection is less common because the catheters are less traumatic. Whether the reduced incidence of cholesterol emboli is anecdote or fact is conjectural.Small (6 Fr) and smaller (4 Fr) catheters both gave good results in this study. The one instance of left main dissection with a 6 Fr catheter does give some credence to the belief that smaller is less traumatic on coronary ostia.Recoil is more frequent with smaller catheters and requires change of size, for example, JL4 to JL5, to resolve the problem, whereas in the preceding study three patients needed to cross over to the larger catheter size.Safety, quality, and duration of study are addressed and are similar without the use of closure devices. Time to ambulation was about 90 min in both groups. Volume of contrast used for routine arteriography was unnecessarily generous (10 ml for the left and 6 ml for the right coronary) and is not required when using high-quality imaging systems.