Impact of catheter down-sizing and power injector use on the amount of contrast medium delivered

Abstract

The purpose of this study is to evaluate the effect of catheter down-sizing and power injector use on the amount of contrast medium delivered during diagnostic coronary angiography (CAG). We retrospectively studied 735 patients undergoing diagnostic CAG. Patients were divided into four groups according to catheter size [4 French (Fr) or 5 Fr] and the method of contrast injection (manual or power injection). Total contrast volume, procedure time, number of catheters used and angiogram quality were analyzed. Down-sizing catheters from 5 Fr to 4 Fr reduced the amount of contrast medium in both manual injection (from 153 ± 22 to 137 ± 17 ml, -10%, p < 0.0001) and power injection (from 135 ± 12 to 125 ± 16 ml, -7%, p < 0.0001). Introduction of power injection reduced the amount of contrast medium in both 4-Fr catheters (from 137 ± 17 to 125 ± 16 ml, -9%, p < 0.0001) and 5-Fr catheters (from 153 ± 22 to 135 ± 12 ml, -12%, p < 0.0001). A 28-ml (18%) reduction in contrast medium volume occurred when catheter down-sizing was combined with power injector use. Angiogram quality was not different among the four groups. Down-sizing the catheters from 5 Fr to 4 Fr and the use of a power injector reduced the amount of contrast medium delivered in CAG without reducing angiographic image quality.

The principles of ultra-low contrast percutaneous coronary intervention

“… 4 , 5 Smaller French guide catheters including slender PCI technique may reduce the contrast volume. 6 Confirm successful engagement of the guide catheter by noting transient ST segment depression in the ECG monitor by injecting 10 ml of saline or by-passing coronary guidewire down into the coronary artery. 8 Take additional guidance from fluoroscopic markers like coronary calcification, post-surgical clips etc.…”

“… 4 In order to reduce the volume of contrast, preferably use small diameter catheter (5 Fr or less) without side holes, small syringes (3–5 cc) and biplane imaging system. 6 Dilute the contrast with saline and optimally engage the vessel to make the most use of contrast. Use increased acquisition rates (30 frames/sec) to improve vessel visualization with minimal contrast load during CAG and to evaluate the final result after ULCPCI.…”

New methods in diagnosis and therapy Successful percutaneous coronary intervention using a 4-in-3 “Slender Mother and Child” PCI technique

“…This progressive reduction in catheter size has been associated with a progressive decrease in complications, mainly those related to the access site [2–4]. In addition, down-sizing of catheters has reduced the volume of contrast medium that must be injected [5]. Although PCI using a 5-Fr guiding catheter is expected to attenuate complications such as bleeding and radial artery occlusion, virtual 3-Fr PCI using a 5-Fr sheathless guiding catheter could lead to less invasive PCI as a result of reduction in puncture size [6].…”