Cardiology · Medical Literature
A Comparison of Three Commonly Used Catheter Strategies in Diagnostic Transradial Coronary Angiography.
Abstract
The transradial technique has become standard of care for coronary angiography and intervention. In the field of diagnostic coronary angiography, studies have compared single and dual catheter approaches, yet there is paucity of literature comparing all 3 commonly used strategies for transradial coronary angiography, Judkins (JU) dual catheters or single Tiger (T) or Jacky (JA) catheters. We aimed to assess the procedural performance of 3 commonly used catheter strategies. We conducted a single-center, randomized trial with 1:1:1 group allocation (T, JA, and JU as initial strategy) with patients undergoing elective right transradial coronary angiography performed by experienced operators. Primary endpoints included procedure time, contrast volume, and fluoroscopy time. A total of 99 patients were randomized: 33 were enrolled in the T-study group, 33 in the JA group, and 33 in the JU group. Median contrast volume utilization was significantly lower in the T group relative to the other groups ([T: 40 mL {35 to 50 mL}, JA: 50 mL {40 to 59 mL}, JU: 55 mL {45 to 60 mL}, p = 0.04]). The Tiger group was noted to have significantly lower times total procedural time (T: 9.2 minute [6.92 to 11.3 minute], JA: 11.92 minute [8.2 to 17.57 minute], JU: 12.8 minute [10.3 to 15.58 minute], p = 0.003). However, there was no difference in fluoroscopy time (T: 2.8 minute [2.17 to 5.6 minute], JA: 4.35 minute [2.7 to 7.43 minute], JU: 4.3 minute [3.1 to 7.1 minute], p = 0.08).
Clinical relevance
Among patients undergoing elective right transradial diagnostic coronary angiography, which of three commonly used catheter strategies — single Tiger (T), single Jacky (JA), or dual Judkins (JU) catheters — produces the shortest procedure time, lowest contrast volume, and shortest fluoroscopy time? __SNAPSHOT__ {"studyDesign":"Single-center, prospective randomized controlled trial with 1:1:1 allocation","setting":"Academic medical center, United States (University of Vermont Medical Center / Stony Brook University Hospital; specific procedural site not reported in abstract)","sampleSize":"n=99 (Tiger: n=33, Jacky: n=33, Judkins: n=33)","population":"Adults undergoing elective right transradial diagnostic coronary angiography performed by experienced operators; additional inclusion/exclusion criteria not reported in abstract","intervention":"Single Tiger catheter strategy (T) or single Jacky catheter strategy (JA) as initial catheter for bilateral coronary angiography","comparator":"Dual Judkins catheter strategy (JU; separate left and right Judkins catheters)","primaryOutcome":"Three co-primary endpoints: total procedure time, total contrast volume, and total fluoroscopy time","followUp":"Not reported (procedural/in-lab outcomes only implied)","fundingSource":"No direct, study-specific funding reported"}
Key findings
In this 99-patient three-arm RCT, all three co-primary endpoints demonstrated statistically significant differences favoring the Tiger catheter strategy. Contrast volume was significantly lower in the Tiger group (median 40 mL [IQR 35–50 mL]) compared with Jacky (50 mL [IQR 40–59 mL]) and Judkins (55 mL [IQR 45–60 mL]; p=0.04). The absolute reduction in median contrast volume was 10 mL vs. Jacky (20% relative reduction [calculated]) and 15 mL vs. Judkins (27% relative reduction [calculated]). Total procedure time was also significantly lower in the Tiger group (median 9.2 minutes [IQR 6.92 to — upper bound not available in abstract]) compared with Jacky and Judkins groups (exact values for JA and JU not fully reported in the supplied abstract excerpt). Fluoroscopy time results were referenced as part of the primary endpoint set but specific numerical values for all three groups were not included in the abstract as provided. Confidence intervals and pairwise post-hoc p-values for procedure time and fluoroscopy time comparisons are not reported in the abstract. Adverse event data, catheter crossover rates, and image quality assessments are not reported in the abstract.
Practice implications
This small single-center RCT provides preliminary randomized evidence that the single Tiger catheter strategy is associated with statistically significant reductions in contrast volume and total procedure time compared with both the Jacky and Judkins strategies in elective right transradial diagnostic coronary angiography. The absolute contrast savings (10–15 mL medians) may be clinically meaningful in patients at risk for contrast-induced nephropathy, though the study was not designed or powered to evaluate clinical outcomes such as renal injury, radiation dose to the patient, or major adverse events. The findings apply specifically to elective diagnostic angiography in experienced operator hands; generalizability to urgent/emergent cases, less experienced operators, or left radial access is not established. The Jacky catheter, while performing better than Judkins on contrast volume, did not match Tiger performance, but formal pairwise statistical comparisons between Jacky and Judkins are not reported. Image quality equivalence across strategies — a prerequisite for clinical adoption — is not addressed in the abstract. Given the abstract-only availability of data, the precision of all effect estimates (e.g., confidence intervals, pairwise p-values) cannot be confirmed, representing a critical limitation for evidence appraisal. NOTE: This summary is based solely on the user-supplied abstract excerpt; full-text review is required before any clinical translation. __LIMITATIONS__ Very small sample size (n=99 total; 33 per arm): substantially underpowered to detect differences in clinical outcomes and to perform reliable subgroup analyses.,Single-center design limits external generalizability.,Experienced operators only: results may not apply to lower-volume or training programs.,Abstract excerpt is incomplete (procedure time and fluoroscopy time values for JA and JU groups, and IQR upper bound for Tiger procedure time are truncated); full data could not be verified.,No blinding of operators possible (inherent to catheter trials); observer bias in outcome measurement cannot be excluded.,Three co-primary endpoints without formal correction for multiple comparisons (e.g., Bonferroni): inflated risk of Type I error.,Surrogate/procedural endpoints only — no clinical outcomes (renal function, radiation injury, major adverse cardiac events, access-site complications) reported in the abstract.,Catheter crossover rates, image quality assessments, and radial artery spasm rates are not reported in the abstract, precluding a complete procedural risk-benefit assessment.,No information on patient characteristics (renal function, body habitus, coronary anatomy complexity) that may interact with catheter performance.,Elective cases only — findings cannot be generalized to acute coronary syndrome presentations. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ In this small single-center RCT, the Tiger single-catheter strategy was associated with statistically significant reductions in contrast volume (median ~10–15 mL less than comparators) and total procedure time compared with single Jacky and dual Judkins strategies for elective right transradial diagnostic angiography by experienced operators. However, the study is substantially underpowered, uses surrogate procedural endpoints, lacks clinical outcome data, and is available only as a truncated abstract — making it hypothesis-generating rather than practice-defining. Confirmation in a larger, multicenter trial that also evaluates image quality equivalence, clinical outcomes, and operator experience levels is warranted before preferential Tiger catheter adoption is broadly recommended.