A PROSPECTIVE RANDOMIZED TRIAL OF NOVOSTE RIGHT VERSUS JUDKINS CATHETERS FOR ENGAGEMENT OF THE RIGHT CORONARY-ARTERY DURING DIAGNOSTIC CATHETERIZATION

There has been little technical advancement in catheter shape for diag nostic cardiac catheterization since the early reports of Sones and co lleagues during the development of the procedure. In order to determin e the utility of a new catheter that directly, without torque or rotat ion, engages the right coronary artery (RCA), one hundred patients wer e randomized between 6Fr standard RCA Judkins (6Fr R4) (Cordis Corpora tion, Miami, FL, USA) or 6Fr Novoste RCA catheters (Novoste Corporatio n, Aguadilla, Puerto Rico). Endpoints included the duration of the var ious aspects of the procedure and a qualitative and quantitative asses sment of angiographic quality. The Novoste RCA catheters were associat ed with statistically decreased times of catheter insertion (42 +/- 37 vs 90 +/- 119 secs), and engagement (31 +/- 35 vs 77 +/- 117 secs), o f the right coronary artery as compared to Judkins catheters. Judkins RCA catheters had a significantly higher primary success rate (96%) th an the Novoste group (84%, P = 0.045). There was no difference in angi ographic quality in either group and no complications occurred during the study. While taller patients (mean 68 in) had increased success wi th the Novoste catheter, no other clinical, demographic, or anatomical characteristics of the RCA orifice predicted successful engagement an d angiography. The direct engagement Novoste RCA catheter is associate d with a more expeditious procedure than Judkins catheters when they c an engage the RCA orifice. However, Novoste catheters were less succes sful and required more frequent exchanges to complete the procedure.