Chapter 14: Must-Have Diagnostic Catheters

The goal of diagnostic cardiac catheterization is to obtain high-quality hemodynamic and angiographic data in an expeditious and safe manner. Radial access provides the operator and patient with a margin of comfort, convenience, and safety that is not offered by the femoral approach. While radial-based cardiac catheterization requires the operator to learn new skills, the basic principles of angiography stand and are supported by technical modifications and radial specific equipment.

Native Coronary Angiography and Left Ventriculography

Standard Catheters

Radial angiography is easily performed using standard Judkins left and right catheters. Though the Judkins catheters are familiar to most operators, some procedural adjustments are necessary when using the right radial approach. When operating from the right side, the angiographer should consider using a Judkins left that is a half size smaller than what they would typically use from the femoral approach (e.g., 3.5 rather than a standard 4.0). After advancing the Judkins left into the ascending aorta, it is convenient to withdraw the guide wire into the catheter while gaining position in the left coronary cusp. It is helpful to perform a guide wire exchange of the left catheter for the Judkins right to avoid repeated navigation of the subclavian. The Judkins right 4.0 is able to engage a majority of right coronary ostia in a fashion similar to the femoral approach. Some operators prefer using the larger 5.0 curve.

Author: 
Amer K. Ardati, MD, MSc, FACC