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 spasm, which reduces the use of more doses of spasmolytic medication and facilitates completion of diagnosis without using supplementary catheters and crossover to another arterial access with consequent expenditure on material; and c) reduced consumption of radiological contrast. Although savings per unit are low (22 € /procedure), the long-term impact could be very important. Also, reduced use of iodinated contrast and the decrease in radial spasm could also reduce the indirect economic costs derived from CIN and crossover to transfemoral access. Limitations of the study Firstly, this study is an observational analysis with inherent biases. However, this is one of the largest studies to evaluate the impact of using a one-catheter strategy with TIG I catheters in invasive coronary procedures. Secondly, data refer to the population of our geographic area and, therefore, cannot be fully extrapolated to other geographic areas. Thirdly, the performance of ventriculography and the diagnostic coronary procedure protocol may differ between different cath labs. However, we consider that our coronary angiography protocol can be considered conservative in the administration of contrast by excluding ventriculography and limiting the number of angiographic views and the volume of iodinated contrast per angiographic view and, for these reasons, we consider that comparison groups were well‑balanced and the final volume of contrast administered was not overestimated. Fourthly, the type of material used (sheaths and catheters), as well as the size of radial sheaths can influence the development of radial spasm. The absence of detailed data regarding the size of the radial sheaths is a limitation of our study. However, the use of hydrophilic sheaths and widely-used catheter trademarks allow our data to be extrapolated to other cath labs. Fifthly, the economic analysis contemplates only the direct costs of the diagnostic coronary procedure and they refer to the prices in our institution. Nevertheless, our study is the first one evaluating total direct economic costs related to one-catheter strategy for coronary angiography. Also, as the savings are conditioned by the lower use of catheters and radial spasm and by the reduction in contrast administration, we consider that results could be easily transferable to other centres. Conclusions The performance of diagnostic coronary angiography using the one-catheter strategy, with TIG catheters, was associated with better performance, in terms of radial spasm, administration of iodinated contrast and economic savings in diagnostic coronary procedures than conventional two‑catheter strategy. Author contributions Conception and design of the research, Acquisition of data, Analysis and interpretation of the data, Statistical analysis, Writing of the manuscript and Critical revision of the manuscript for intellectual content: Costa-Mateu J, Fernández‑Rodríguez D, Rivera K, Casanova J, Irigaray P, Zielonka M, Pereyra-Acha E, Aldomà A, Worner F. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork Ethics approval and consent to participate This study was approved by the Ethics Committee of the Hospital Arnau de Vilanova de Lleida under the protocol number PI 13/16. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 1. 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