Single vs dual catheter for transradial approach - John Coppola

1. John Coppola MD FACC
NYU Langone Medical Center

2. Disclosures
 None

3. Why
 Cost
 Spasm
 Radiation
 Time
 teaching

4. Me in school

5. Looked at my data

6. Old dog vs pups
 Random sample 50 cases 2 catheter vs single catheter
operators in teaching hospital
 Dual 3.3 minutes fluro time vs 4 minutes

7. World wide 2010
 For left system
 JL3.5 44.9%
 JL4 21.6
 For RCA
 58.8% used JR4
J Am Coll Cardiol Intv 2010;3:1022-31

8. reasons

9. cost
 Single catheter Jacky /Tiger $45 =38E
 Multiple $ 8 6.7E would need to use over 5 catheters
to be equal cost

10. Teaching
 In US still greater than 50% femoral
 All about hand eye coordination
 Easier to teach fellows

11. Taking fellows from left to right

12. Radial in Greece
year 2004 2009 2013 2016
diagnostic 0.43 12.3 39.8 81.1
PCI 0.38 9.2 39.5 79.3

13. Catheters used
LCA RCA
JL3.5 67% JR4 77.6
JL4 10.2 Tiger 20.4
Tiger 22.4 Amplatz 2.1

14. Initial excitement
Internation Journal of Cardiov imaging
2006;22:295-303

15. Initial data

16. When it works

17. One catheter vs 2
 1,419 patients
 >80 TRA qualified
 <80 TRA nonqualified
 Only 2 operators with > 1,000 TRA no difference in
outcome
International J Cardiol 2015;187:680-82

18. Tiger performance
Intern Journal of Cardiol 2015;187:680-
82

19. Tiger performance
International Journal Cardiol 2015;187:680-82

20. Using Left Judkins vs 2 catheters
 JL3.5 for both vs JR4 JL 3.5
 JL3.5 successful in 66%
 Overall greater fluro time when using single catheter
 When it worked similar fluro time
J Interven Cardiol 2016;29:257-264

21. Using JL3.5
J Interven Cardiol 2016;29:257–264

22. Standard vs Radial specific
 Senior interventional fellows
 110 patients
 57 Tiger 53 Judkins
 14% of time Tiger crossed over
 Shorter Fluro time with TIGER but
Am J Cardiol 2016;118:357-
361

23. Yet another study

24. 184 vs 238

26. pride
 However insisting on a single-catheter approach with
JL could unnecessarily
 increase fluoroscopy time and, hence, radiation
exposure. (J Interven Cardiol 2016;29:257–264)

27. reasons

28. Radiation Exposure

29. CCI 2017;90:243-48

30. CCI 2017;90:243-248

31. Single vs dual catheter
CCI 2017;90:243-248

32. Radial spasm

33. Predictors spasm

34. Predictors spasm

35. Predictors spasm

36. conclusions
BE happy Learn TRI