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

Abstract

Compared with 6F catheters, diagnostic coronary angiographic and ventriculographic images with 4F catheters can be obtained with equivalent results using less radiographic contrast volume. Whether 4F coronary angiography would be superior using a power-assisted, operator-controlled technique compared with manual technique is unknown. To determine whether 4F coronary angiography using operator-controlled power injection (Acist, Minneapolis, MN) was equivalent or superior to the 4F manual technique, 96 unselected patients undergoing transfemoral coronary angiography were randomized to 4F catheter using a power injection or manual technique. Procedural characteristics and angiographic quality scores were analyzed. Comparing the 4F manual with the 4F power-injection technique, coronary angiographic quality scores were equivalent (left coronary artery 4.7 +/- 0.5 vs. 4.7 +/- 0.6, P = 0.99; right coronary artery 4.94 +/- 0.2 vs. 4.88 +/- 0.1, P = 0.21). Left ventriculography scores were lower in 4F Acist with similar contrast volumes. The total study contrast volume was significantly less in the 4F Acist group (119 +/- 35 vs. 149 +/- 49 ml, P = 0.001). Compared with the 4F manual contrast injection technique, diagnostic angiography through 4F catheters with power contrast injection resulted in equivalent coronary angiographic image quality with significantly less radiographic contrast volume.

Meta-Analysis of the Effect of Automated Contrast Injection Devices Versus Manual Injection and Contrast Volume on Risk of Contrast-Induced Nephropathy

“…Two studies are a continuation of each other, the only difference being 5 additional patients included in the manual injection group. (4, 7) However, after excluding the second study with 5 additional patients, we determined that there were still statistically significant lower volumes of contrast administered for diagnostic catheterizations. Second, the nature of the studies do not allow for equipoise or blinding; 2 studies report randomization techniques, 1 of which employed a faulty strategy, and none report withdrawal or dropout rates, creating an overall low Jadad score (Table 2).…”

“…(4, 6-8) One study concluded no difference in the amount of contrast volume delivery, while 3 reported significantly less contrast volume use when using the 4F automated injection compared with manual technique. (4, 6, 7) Overall, 5.53 ml (p = 0.01, 95% CI, -9.91, -1.16) less contrast was delivered in the ACIST group compared to the manual group employing automated injectors for left ventriculography only. However, our meta-analysis does not have the ability to explore the causal role of catheter size on contrast volume or CIN endpoints.…”

“…(1-7) Studies have varied in the reported reduction of contrast for diagnostic catheterization. (1-4, 6-9) Others also include the contrast volume utilized during percutaneous coronary intervention (PCI). (1-5, 7, 9) However, there is a significant gap in summarizing the evidence in the published literature.…”

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

“…However, angiographic quality also decreased [20]. It was reported in 2001 that 4-Fr angiography with the ACIST power injector resulted in image quality similar to that with 4-Fr manual injection technique with significantly reduced contrast medium usage [21]. Thus, the combination of catheter down-sizing with power injector use is effective in reducing the amount of contrast medium delivered without reducing angiographic quality.…”

Qualitative comparison of coronary angiograms between 4 french catheters with an Advanced Cardiovascular Injection System and 6 french catheters with manual injection

“…Furthermore, there is a continued effort to reduce vascular complications and the amount of contrast used, and to reduce procedure length and time to postprocedure ambulation, while maintaining excellent image quality [1–3]. Data are not conclusive regarding the potential advantage of smaller diagnostic catheter use for cardiac angiography in relation to the aforementioned parameters [8–13].…”