Procedural and clinical performance of dual‐ versus single‐catheter strategy for transradial coronary angiography: A meta‐analysis of randomized trials

Abstract

Objectives: We sought to compare the procedural and clinical performance of dual-versus single-catheter strategy for transradial coronary angiography. Background: The radial artery (RA) is recommended as the vascular access of choice in patients undergoing coronary angiography and intervention. The procedural and clinical performance of dual-versus single-catheter strategy in patients undergoing transradial coronary angiography remains a matter of debate. Methods: This is a study-level meta-analysis of randomized trials. The primary outcome was procedure time. The main secondary outcome was fluoroscopy time. Other outcomes of interest were contrast volume, crossover to other catheter strategy and RA spasm. Results: A total of 2,062 patients (978 randomly assigned to dual-catheter and 1,084 to single-catheter strategy) included in seven trials were available for the quantitative synthesis. A dual-catheter strategy was associated with procedure time (standardized mean difference [95% confidence intervals (CI)], 0.55 [−0.69, 1.78]; p = .32), fluoroscopy time (−0.36 [−2.39, 1.67]; p = .68) and contrast volume (−0.93 [−3.79, 1.94]; p = .44) comparable to a single-catheter strategy. The risk for crossover was lower (risk ratio [95% CI], 0.14 [0.03, 0.70]; p = .025) while the risk for RA spasm was higher (1.81 [1.54, 2.12]; p < .001) among patients assigned to dual-versus single-catheter strategy. Conclusions: This meta-analysis provides evidence for a comparable procedural performance of either dual-or single-catheter strategy for transradial coronary angiography. The fewer crossovers with dual-catheter strategy occur at the expense of more frequent radial artery spasm.

Right and left coronary artery angiography with single Judkins left catheter via right radial artery

“…Numerous studies have been conducted to investigate the dual versus single catheter strategy in transradial coronary angiography [10]. The common goal of these studies was to show that a single catheter is at least as effective as a double catheter and less complications occur.…”

“…Radial artery spasm was also detected more frequently in the dual catheter group. In a meta-analysis investigating the performance of standard shaped-JL or custom catheters for transradial coronary angiography, less spasm was detected in the single catheter group [10]. However, more crossovers were made compared to the dual catheter strategy.…”

Culprit vessel revascularization first with primary use of a dedicated transradial guiding catheter to reduce door to balloon time in primary percutaneous coronary intervention

“…One way to shorten D2B time is to perform transradial coronary angiography using a STGC. Several randomized trials have investigated the performance of either standard Judkins-shaped or dedicated catheters (Tiger II, Kimny, and DxTerity) for transradial coronary angiography (21)(22)(23). The potential objective of introducing the STGC method of transradial intervention is to avoid catheter exchange and achieve shorter procedural times.…”

One or two diagnostic catheters with radial access: Does single yield celerity or double cause trouble?

“…In this issue of Catheterization and Cardiovascular Interventions , Alushi et al attempt to answer the question of whether diagnostic catheterization using radial access can be performed more efficiently using a single “universal” catheter designed to access both coronary ostia, rather than one catheter designed for the left main coronary artery and a second designed for the right coronary artery 1 . In brief, their analysis failed to demonstrate that one is better than two but does not exclude the possibility that this will be proven by future studies.…”

“…In their meta‐analysis, Alushi et al included seven trials with 2,062 patients randomized between a dual‐catheter strategy (Judkins 3.5/4 left and right catheters) and a single‐catheter strategy (most commonly the Tiger catheter [Terumo Medical Corporation] or a “Tiger‐like catheter”) 1 . They compared procedural times, fluoroscopy times, contrast volume, rate of crossover to an additional catheter, and incidence of radial spasm.…”