Coronary angiography using 4 Fr catheters with acisted power injection: A randomized comparison to 6 Fr manual technique and early ambulation

Abstract

Coronary angiography using 4 Fr catheters may reduce access site complications, promote better utilization of outpatient facilities, but at a cost of suboptimal image quality. To determine whether 4 Fr diagnostic angiography with power injection (Acist, Minneapolis, MN) was equivalent to 6 Fr manual technique, 101 unselected patients were randomized to transfemoral coronary angiography with 4 or 6 Fr catheters. Procedural characteristics, angiographic quality scores, and results of 90 min ambulation were analyzed. Coronary angiographic quality scores using 4 Fr and 6 Fr catheters were equivalent (left coronary artery 4.73 +/- 0.6 vs. 4.80 +/- 0.65, P = 0.28; right coronary artery 4.98 +/- 90.13 vs. 4.97 +/- 0.16, P = 0.48). However, 4 Fr left ventriculographic image score was lower (4.53 +/- 0.68 vs. 4.83 +/- 0.42, P = 0.0002), attributed, in part, to a smaller injected contrast volume (32 +/- 11 vs. 37 +/- 4 mL, P = 0.001). The total study contrast volume was significantly less in the 4 Fr group (119 +/- 35 vs. 159 +/- 52 mL, P = 0.001). Complications related to early ambulation at 90 min were similar and minimal in both groups. Compared to 6 Fr manual contrast injection technique, diagnostic angiography through 4 Fr catheters with power contrast injection resulted in equivalent coronary angiographic image quality, slightly reduced but diagnostic left ventricular image quality, and significantly less contrast volume. Four Fr angiography facilitates early ambulation without compromising safety and image quality.

Randomized comparison of coronary angiography using 4F catheters: 4F manual versus “Acisted” power injection technique

“…However, the use of smaller catheters (Յ5F) has been limited by variable and suboptimal catheter handling and angiographic image quality using the traditional manual injection technique [4,5]. A recent trial in our laboratory comparing safety, image quality, and early ambulation between the 6F manual technique and the 4F powerassisted technique demonstrated equivalency for both image quality and ambulation times with the 4F catheters [6]. In addition, less radiographic contrast was used for patients in the 4F group.…”

“…Operator preference for precise control of the speed and volume of contrast delivery by the operator can be achieved instantaneously with a manually variable power injector. Contrast delivery through small catheters with this injection system has overcome the limitations of both manual and fixed power injection systems in providing adequate artery opacification through small catheters [6]. However, it is unknown whether vigorous manual contrast injection could produce coronary angiographic images equivalent to those of power injection.…”

“…Because of catheter downsizing for both diagnostic and interventional procedures and the associated concern for optimal image quality, the use of an operator-controlled variable power-injection contrast delivery system for coronary angiography has recently been introduced [6]. Operator preference for precise control of the speed and volume of contrast delivery by the operator can be achieved instantaneously with a manually variable power injector.…”

A novel method of ultra-low contrast administration for coronarography and percutaneous coronary intervention using the automatic injector. The need to focus on contrast preservation techniques

“…4 Fr) and reduce patient contrast dose and fluoroscopy time [7,8]. They allow for monitoring of pressure at the catheter tip and have the inbuilt safety feature of response to the intensity of the operator's pressure on the control handle.…”

Are you dyed‐in‐the‐wool?

“…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.…”