DIAGNOSTIC BRACHIAL CORONARY ARTERIOGRAPHY USING A POWER-ASSISTED INJECTOR AND 4 FRENCH CATHETERS WITH NEW SHAPES

Background. Right brachial access in diagnostic coronary arteriography (CAG) has demonstrated advantages over femoral approaches, including earlier ambulation and more predictable hemostasis, particularly when small diameter catheters were used. Poor results from some earlier rep orts of brachial CAG have been due partially to the need to use large diameter catheters for positional control. Technical advances in cathe ters and contrast injection may increase the utility of brachial acces s CAG. Purpose and study design. We evaluated three 4 French (Fr) cath eters with new shapes and with a large internal to external diameter r atio that were designed to overcome previous limitations to brachial C AG. Contrast agent was delivered with a novel power injector (CAG-20) intended for arteriography using small catheters. Routine right brachi al access CAG and left ventriculography (LVG) were evaluated in 2663 ( 69%) of 3880 consecutive patients admitted for examination from 1991 t o 1995. The study population included 128 patients (5%) with left main trunk disease, 819 (21%) with old myocardial infarctions and 1747 (66 %) with more than one vessel disease. For this trial, 1217 patients wi th valvular disease, ischemia associated with aortic or peripheral vas cular disease, congenital cardiac disease and post-surgical and emerge ncy catheterization were excluded because femoral access or a larger c atheter (> 4 Fr) were required in those cases. Results. A total of 257 3 (97%) diagnostic quality CAG (>grade 3/5) were obtained solely with 4 Fr catheters placed via the right brachial artery. Of the other 66 e xaminations, 50 were completed through the brachial route but with alt ernate size or shape catheters and 16 cases required the femoral Judki n's technique. Useful LVG (>grade 2/4) were obtained from 2604 patient s (98%). Overall, 2536 (95%) of cases provided clinically valuable ima ges for both CAG and LVG from brachial access. We experienced one semi -emergency bypass operation and one emergency stent implantation cause d by coronary dissection. There were no deaths, acute myocardial infar ctions, loss of pulse or nerve injuries. Conclusion. Power-injector as sisted, brachial 4 Fr CAG and LVG proved to be safe and cost-effective . Brachial access has the potential to become a routine method for out -patient cardiac opacification.