TY  - BOOK
AU  - Case, Brian Christopher
AU  - Chen, Yuefeng
AU  - Chezar-Azerrad, Chava
AU  - Forrestal, Brian John
AU  - Hashim, Hayder
AU  - Khalid, Nauman
AU  - Musallam, Anees
AU  - Shlofmitz, Evan
AU  - Waksman, Ron
AU  - Yerasi, Charan Teja Reddy
TI  - Right transradial coronary angiography in the setting of tortuous brachiocephalic/thoracic aorta ("elephant head"): Impact on fluoroscopy time and contrast use
SN  - 1522-1946
PY  - 2022///
KW  - *Elephants
KW  - Animals
KW  - Aorta, Thoracic/dg [Diagnostic Imaging]
KW  - Cardiac Catheterization/ae [Adverse Effects]
KW  - Cardiac Catheterization/mt [Methods]
KW  - Coronary Angiography/ae [Adverse Effects]
KW  - Coronary Angiography/mt [Methods]
KW  - Female
KW  - Fluoroscopy
KW  - Humans
KW  - Male
KW  - Radial Artery/dg [Diagnostic Imaging]
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006
N2  - BACKGROUND: Unfavorable anatomy with severe brachiocephalic/thoracic tortuosity, referred to as an "elephant head," remains a significant obstacle for RTCA; CONCLUSIONS: For patients undergoing RTCA with significant brachiocephalic/thoracic aorta tortuosity, "elephant head," a Tiger catheter can be used efficiently for curvatures <1 cm from the middle of the spine. We propose that for curvatures >1 cm, operators should consider immediately switching to a JL catheter. Copyright (c) 2021 Wiley Periodicals LLC; METHODS: We reviewed the coronary angiograms of patients who underwent RTCA and had tortuous aortas. Angiography was attempted first using a universal catheter (Tiger) and switched to a left coronary specific catheter (Judkins Left [JL]) if challenging. Fluoroscopy time, contrast volume, and greatest distance from the patient's midline to the catheter in the aorta were recorded; OBJECTIVES: Assess the impact on fluoroscopy time and contrast use in patients with tortuous brachiocephalic/thoracic aortas undergoing right transradial coronary angiography (RTCA) and provide strategies to manage; RESULTS: Forty-nine patients (62.6 +/- 12.0 years, 69.4% male) were included. Fifteen (30.6%) patients underwent successful angiography with a Tiger catheter; 34 (69.4%) patients required switching to JL catheter. The average distance of Tiger catheters to the midline of the spine was 0.78 +/- 0.41 cm versus 1.28 +/- 0.44 cm (p = .001) in JL catheters. Tiger catheter use resulted in less fluoroscopy time (6.48 +/- 4.73 min) and contrast use (58.87 +/- 43.53 ml) than in cases switched to JL (13.26 +/- 10.76 min [p = .026]; 86.5 +/- 69.95 ml [(p = .017])
UR  - https://dx.doi.org/10.1002/ccd.29470
ER  -