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CLINICAL STUDIES

Scraping of aortic debris by coronary guiding catheters

A prospective evaluation of 1,000 cases

^a Department of Internal Medicine (Cardiovascular Division), William Beaumont Hospital, Royal Oak, Michigan, USA

Manuscript received April 10, 1998; revised manuscript received July 31, 1998, accepted August 20, 1998.

Address for correspondence: Dr. Cindy L. Grines, Director of Cardiac Catheterization Laboratories, William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, Michigan 48073
cgrines{at}beaumont.edu

Objectives. This study was designed to determine the incidence and to quantitate aortic debris retrieved during placement of guiding catheters in patients undergoing percutaneous interventions.

Background. Studies have shown that atherosclerotic aortic debris predisposes patients to spontaneous or procedurally related ischemic events.

Methods. In 1,000 consecutive percutaneous interventions, the amount of visible atheromatous material from large-lumen-guiding catheters was recorded. Clinical characteristics and in-hospital complications were prospectively collected and associated with debris production.

Results. Visible aortic debris (1+ to 3+) occurred more frequently with the Judkins left (JL) catheter, followed by the multipurpose (Multi) catheter compared to any other type of guiding catheter (65%, p = 0.001 and 60%, p = 0.01, respectively). Large debris (2+ and 3+) was observed most frequently with the Multi (odds ratio 3.79, C.I. = 2.32 to 6.21, p = 0.001), JL (odds ratio 2.83, C.I. = 1.98 to 4.05, p = 0.001) and voda left (VL) (odds ratio 2.73, C.I. = 1.51 to 4.95, p = 0.001) catheters. The Judkins right (JR) catheter type was least likely to produce any debris (24%, p = 0.001). A history of unstable angina (p = 0.05) or myocardial infarction (p = 0.003) was associated with a decreased incidence of debris production. The presence of debris was not found to be associated with in-hospital ischemic complications.

Conclusions. Studies have shown that atherosclerosis of the aorta is a potential source of systemic embolism in patients undergoing cardiac catheterization. Our study shows that in more than 50% of percutaneous revascularization procedures, guiding catheter placement is associated with scraping debris from the aorta. Design characteristics of the JL, Multi and VL guiding catheters make them most likely to produce such debris. Meticulous attention to allow the debris to exit the back of the catheter is essential to prevent injecting atheromatous debris into the vascular bed.

Abbreviations and Acronyms   AL = Amplatz left   AR = Amplatz right   HS = hockey stick   JL = Judkins left   JR = Judkins right   LIMA = left internal mammary artery   Multi = multipurpose   VL = voda left

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