World Journal of Cardiovascular Diseases, 2013, 3, 581-584 WJCD
http://dx.doi.org/10.4236/wjcd.2013.39091 Published Online December 2013 (http://www.scirp.org/journal/wjcd/)
Performance of single reshaped Judkins left catheter for
transradial coronary angiography
Guangming Zhang, Wei Cui*, Ruiqin Xie, Fan Liu, Guoqiang Gu, Jingchao Lu, Hongmei Zheng,
Xiuchun Yang, Xiaohong Yang
Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
Email: *cuiwei@medmail.com.cn
Received 21 September 2013; revised 25 October 2013; accepted 8 November 2013
Copyright © 2013 Guangming Zhang et al. This is an open access article distributed under the Creative Commons Attribution Li-
cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: To investigate the feasibility of single
reshaped Judkins left catheter for transradial coro-
nary angiography. Methods: A total of 198 consecu-
tive patients were enrolled in the first step study. Pa-
tients were randomly assigned to brachial type cathe-
ter group (BRACT group) or Judkins left catheter
group (Judkins group). The inclusion criterion was
the left coronary angiography which could be accom-
plished by either a brachial type catheter or a reshap-
ed Judkins left catheter. The successful procedure
was defined as both right and left coronary angiogra-
phy could be completed with a single reshaped Jud-
kins left catheter or a brachial type catheter. Further-
more, 1873 consecutive patients were continuously
enrolled to observe the success rate of single Judkins
left catheter for transradial coronary angiography.
Results: Of the 198 patients, 191 were finally enrolled
in this study according to the inclusion criteria, with
95 patients in BRACT group and 96 in Judkins group.
There were no significant differences on baseline be-
tween the two groups. Procedure success rate was
84.10% with a fluoroscopic exposure time of 3.81 ±
0.43 min in BRA-CT group, and 81.60% with a fluo-
roscopic exposure time of 4.05 ± 0.48 min in Judkins
group (P > 0.05). No severe complications were found
in either of the two groups. The success rates of 1869
patients with single Judkins left catheter for transra-
dial coronary angiography were 75.33%. There were
no complications in tho se patien t s. C o nc lu si o ns : Tr an -
sradial coronary angiography with a reshaped single
Judkins left catheter is feasible and practical, with an
accepted procedure success rate. This method should
be worthy of further clinical validation in a larger
scale population.
Keywords: Coronary Angiography; Transradial; Judkins
Left Catheter
1. INTRODUCTION
Transradial coronary percutaneous procedures are asso-
ciated with reduced entry site complications compared to
transfemoral [1], and transradial procedures are beco-
ming widely accepted by operators and patients because
of the patients resuming activity immediately after the
procedure and avoiding the discomfort of forced, pro-
longed bed rest. But one of the drawbacks for transradial
procedures is related to the possibility of radial artery
damage, which is mostly related to the insertio n of over-
sized sheaths, but possibly also to catheter exchange [2].
Potential consequences of arterial injury are spasm and
radial artery occlusion.
The purpose of this study was to evaluate the feasi-
bility of single reshaped Judkins left catheter for enga-
ging both coronary arteries via the right transradial artery
approach, compared with conventional brachial type
catheter BRACT.
2. METHODS
2.1. Patient Selection
From January to December 2006, A total of 198 inpa-
tients undergoing transradial diagnostic coronary angio-
graphy or elective percutaneous coronary intervention
were consecutively enrolled in the first step study. Pa-
tients were randomly assigned to Judkins left catheter
group (Judkins group) or brachial type catheter BRACT
group (BRACT group). The inclusion criterion was pa-
tients with a positive Allen test, and only th ose in whom
the left coronary angiography could be accomplished
with either a BRACT catheter or a reshaped Judkins left
catheter were analyzed.
*Corresponding a uthor.
OPEN ACCESS
G. M. Zhang et al. / World Journal of Cardiovascular Diseases 3 (2013) 581-584
582
In addition, from January 2006 to April 2012, included
198 inpatients in above analysis, 1873 inpatients under-
going transradial diagnostic coronary angiography or
elective percutaneous coronary intervention were con-
secutively enrolled. All of them were underoperated with
single Judkins left catheter for transradial coronary an-
giography. All patients provided written, informed con-
sent before catheteri zat i on .
2.2. Judkins Left Catheter Reshaped
Before the Judkins left catheter was used for coronary
angiography, the secondary curve of the regular catheter
was reshaped to a right angle by forcefully sliding the
catheter through fingers in order to obtain a configu-
ration similar to the brachial type catheter (Figure 1).
2.3. Catheterization Procedures
Transradial angiography was performed just as the usual
right radial approach. The radial artery was punctured
with a radial artery needle, and a 0.025’’ guidewire was
inserted through the needle. A 12-cm-long 6F radial
sheath was then inserted. Heparin was given as a bolus
intravenous infusion with a dose of 3000 - 5000 IU. The
sheath was removed immediately after the procedure.
Hemostasis was achieved by radial compression with an
artery compression bandage.
Diagnostic catheters used were either reshaped Jud-
kins Left catheter (MERIT MEDICAL, USA) or the BR-
ACT (MERIT MEDICAL, USA). The selection of diag-
nostic catheter was randomized. Judkins left 3.5 catheters
were usually used, but Judkins left 4.0 catheter was also
selected when ascending aorta was overwrite. When re-
shaped Judkins left catheters were used, after the left
coronary angiography was done, the reshaped Judkins
left catheter was rotated clockwise 90˚ - 180˚ under fluo-
roscopy guidance using a LAO projection, and this ma-
neuver usually made the catheter engage the right coro-
nary artery easily. The skill for th e BRACT catheter was
the similar to that described above.
JL JL r es haped BRACT
(a) (b) (c)
Figure 1. Show the original JL (a) is reshaped (b) to a configu-
ration similar to BRACT catheter (c).
2.4. Observations and Definitions
Procedure success rate: the successful angiographic pro-
cedures were recorded in Judkins group or BRACT
group. The successful procedure was defined as both
right and left coronary angiography could be completed
with a single reshaped Judkins left catheter or a BRACT
catheter. Total fluoroscopic time: four to five conven-
tional projections were used for left coronary angiogra-
phy, and two for right coronary angiography. The total
fluoroscopic time was recorded in every patient during
transradial angiographic procedures. Complications: We
observed the patients until 3rd day after the procedure,
procedure-related complications were observed, inclu-
ding the need for surgical correction of vascular access
site, permanent neurological deficit, radial artery occlu-
sion, and peri-procedural Q-wave or non Q-wave myo-
cardial infarction or death.
2.5. Statistical Analysis
All data were prospectively recorded on standardized
forms. Data are presented as mean standard deviation
for continuous variables and as the percentage for cate-
gorical variables. Continuous variables were analyzed by
an independent-samples t-test. Categorical varia bles
were compared by x2 analysis. Statistical analysis was
performed with the SPSS, version 11.5, software pack-
age (SPSS, Chicago, IL). A P-value < 0.05 was consi-
dered statistically significant.
3. RESULTS
3.1. Baseline Data
Of the 198 patients, 191 patients were eligible for the
study, including 95 patients in BRACT group and 96 in
Judkins group. The JL3.5 catheter was used in 86 patients
and JL4.0 in 10 cases in Judkins group. The mean patient
age was 56.84 ± 9.50 years, with 28.3% females. The
patients in the Judkins group and BRACT group were
well matched for age, sex, and other demographic data
(Table 1).
Of the 1873 patients, 1869 patients were used with
single reshaped Judkins left catheter for transradial coro-
nary angiography, the mean age was 57.99 ± 4.84 years,
27.3% were female. All of the patients had stable hemo-
dynamics and good radial artery pulses (positive Allen
test). The study wer e not include of the other approach if
the radial artery approach failed.
3.2. Procedural Characteristics between Two
Groups
In the Judkins group, 78 of 96 patients were completed
the procedure successfully with a single reshaped Jud-
kins left catheter, with a procedure success rate of
Copyright © 2013 SciRes. OPEN ACCESS
G. M. Zhang et al. / World Journal of Cardiovascular Diseases 3 (2013) 581-584 583
81.25%. While 80 of 95 patients were completed the
procedure with a BRACT catheter, yielding a procedure
success rate of 84.21%. The procedure success rate in the
Judkins group showed no significant difference com-
pared with that in the BRACT group (P = 0.70) (Table
2).
Total fluoroscopic time was 4.28 ± 0.48 min in Jud-
kins group, and 4.21 ± 0.43 min in BRACT grou p. There
were no significant difference in total fluoroscopic time
between the two groups (P = 0.29) (Table 2).
No significantly statistical differences between the
groups regarding to radial artery spasm and angiographic
or clinical complications (Table 2).
3.3. Success Rates of Single Reshaped Judkins
Left Catheter
Of the 1873 patients, 1869 patients were eligible for the
study. Overall, 1408 cases (75.33%) were performed
both left and right coronary angiography with only one
reshaped Judkins left catheter, and 459 cases (24.56%)
were performed with two catheters because the Judkins
left catheter couldn’t reach to right coronary artery
Table 1. Baseline patient’s characteristics.
Judkins group
(n = 96) BRACT group
(n = 95) P-values
Age (years) 56.0 ± 9.9 57.1 ± 8.9 0.17
Male gender (n (%)) 68 (70.8) 73 (76.8) 0.06
Hemoglobin (g/l) 130.1 ± 11.2 135.3 ± 12.6 0.16
BMI (kg/m2) 25.3 ± 3.59 25.7 ± 3.10 0.08
Risk factors (n (%))
Hypertension 64 (66.7) 66 (69.5) 0.36
Hyperlipidemia 29 (30.2) 33 (34.7) 0.26
Diabetes mellitus 20 (20.8) 22 (23.2) 0.33
Smoking 52 (54.2) 52 (54.7) 0.97
Values are expressed as mean ± SD or n (%). P-values derived from inde-
pendent sample t-test for continuous variables or x2 test for categorical
variables. BMI: body mass index.
Table 2. Safety and efficacy between Judkins group and BRA-
CT group.
Judkins group
(n = 96) BRACT group
(n = 95) P values
Success rates (n (%)) 78 (81.25) 80 (84.21) 0.70
Fluoroscopic time (min) 4.28 ± 0.48 4.21 ± 0.43 0.29
Complications (n (%)) 0 (0) 0 (0) 1.00
Values are expressed as mean ± SD or n (%). P-values derived from inde-
pendent sample t-test for continuous variables or x2 test for categorical
variables.
ostium. The other 2 cases had abnormal right coronary
artery ostium that the Judkins right catheter couldn’t
reach to right coronary artery ostium, so we had to use
the Amplatz Right (AR) catheter to reach to right coro-
nary artery ostium.
4. DISCUSSION
In recent years, the transradial approach has been used
increasingly as an alternative to femoral approach for
percutaneous coronary diagnosis and intervention. Most
of the diagnostic catheters that are currently used for
transradial coronary angiography are the Judkins, Am-
platz, which have curves originally designed for a fe-
moral approach. The technical and anatomic aspects of
transradial access are different from those of femoral
access, thus making manipulation of conventional diag-
nostic catheters sometimes difficult an d time-consuming.
Therefore, many attempts have been made to design a
catheter for a transradial approach for routine diagnostic
and interventional coronary procedures, trying to engage
both coronary arteries by one single catheter [3]. For
example, the 5F Tiger II (Terumo Corporation, Tokyo,
Japan) catheters were tested to prove the feasibility,
safety, and performance as a kind of multipurpose
catheter for transradial coronary angiography [4]. The
Brachial Type K (Terumo Outlook, Leuven, Belgium)
catheters were also proved to to perform both left and
right coronary angiography with a single catheter [5].
The diagnostic catheter that currently used for tran-
sradial coronary angiography in most hospitals in China
is the multipurpose brachial type catheter (BRACT).
BRACT catheter is more costly than Judkins, which
limits the useage of BRACT catheter to some extent.
This study demonstrated the feasibility and safety of
single reshaped Judkins left catheter for engaging both
coronary arteries via the right transradial artery ap-
proach.
The present study showed that by using a reshaped
Judkins left catheter, it was possible to successfully per-
form both left and right coronary angiography in 75.33%
of the cases, which was very similar to conventional
radial catheter with respect to procedure success rate and
fluoroscopic time. Moreover, there were no instances of
aortic or coronary dissection. The manipulation of diag-
nostic catheters also did not lead to excessive spasm.
According to our experien ce, the 5F Judkins left catheter
was more suitable for reshaping, although the 6F catheter
can also be reshaped. Another advantage by using a
reshaped Judkins left catheter was that this reshaped
catheter didn’t need a guidewire support for engaging
either the right or the left coronary arteries, even when
the initial attempt for engaging failed. This will simplify
the manipulation and reduce the potential complications
related to guidewire exchange.
Copyright © 2013 SciRes. OPEN ACCESS
G. M. Zhang et al. / World Journal of Cardiovascular Diseases 3 (2013) 581-584
Copyright © 2013 SciRes.
584
5. STUDY LIMITATIONS
OPEN ACCESS
This study is limited by its small sample size. Otherwise,
we didn’t compare reshaped left Judkins catheter with
other catheter designs, including non-reshaped left Jud-
kins catheters, and await confirmation by prospective
analyses.
6. CONCLUSION
Transradial coronary angiography with a reshaped single
Judkins left catheter is feasible and practical, with an
accepted procedure success rate. This method should be
worthy of further clinical validation in a lager scale
population.
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