ABC | Volume 113, Nº5, November 2019

Original Article Costa-Mateu et al. Catheterization with one-catheter strategy Arq Bras Cardiol. 2019; 113(5):960-968 Figure 1 – Design of TIG I and Judkins catheters and cannulation of the coronary arteries. RCA: right coronary artery; LCA: left coronary artery. Methods Population and Study Design This study compared, in an observational and retrospective way, the impact of one-catheter strategy with TIG I catheter (Radiofocus Optitorque 5F; Terumo Europe N.V., Leuven, Belgium) and two-catheter strategy with Judkins catheters (Infiniti® 5F Left and Right Coronary Judkins; Cordis Corporation, Cashel, Ireland) on the amount of iodinated contrast, appearance of radial spasm, duration of the procedures and exposure to ionizing radiations in patients referred for diagnostic coronary angiography in our institution (Figure 1). We collected data on the procedures performed in our institution. For repeated procedures in the same patient, data of each coronary angiography were included separately. The study was conducted according to the principles of the Helsinki Declaration and in compliance with current ethical and legal regulations. All patients signed a written informed consent form before coronary catheterization. Inclusion and exclusion criteria are described below: * Inclusion criteria: – Indication for invasive coronary angiography. – Right radial access. – Patients >18 years. * Exclusion criteria: – Abnormal Allen’s test. – Presence of brachial arteriovenous fistula in right upper extremity. – Need to use 4Fr catheters. – Previous coronary artery bypass grafting surgery. – Performance of ventriculography, aortography or ad hoc coronary angioplasty. – Iodinated contrast allergy previously known that cannot receive pre-medication. – Women with possibility of being pregnant. – Inclusion in other clinical trials or registries. * Endpoints and Definitions: Primary endpoint was total volume (mL) of iodinated contrast used during diagnostic coronary procedures. Secondary endpoints were related to the development of radial spasm, duration of the procedure, exposure to ionizing radiation and economic costs. Radial spasm was defined as the presence of at least two of the following criteria: a) catheter manipulation resistance; b) pain in the arm during catheterization; c) pain after catheter manipulation; d) pain after sheath removal or e) resistance during sheath removal. 4 Duration of the coronary procedure was indirectly evaluated by fluoroscopy time (min). Exposure to ionizing radiation was evaluated by dose-area product (DAP) and air kerma. Economic costs, measured in € per procedure, were defined as the direct attributable costs to each strategy for coronary angiography, including the type and number of catheters, the drugs used in the cath lab, the fungible material and the amount of iodinated contrast used in each procedure. 10,11 Economic costs related to material used for coronary angiography are described in Supplementary Material. 961