Catheter-induced XXXX --a view of mechanical factors and experience with selective left coronary arteriography.

@entity1 @entity662 @entity101 @entity6 @entity3361 @entity412 @entity2473 @entity453 @entity158 @entity583 @entity165
BACKGROUND: @entity3361 during cardiac catheterization is not unusual. The mechanism of @entity2473 remains uncertain, but is considered to be multifactorial. Many researchers believe that @entity3361 that develops during catheterization is partly spontaneous and partly catheter-induced. Because catheter-induced @entity2473 results from mechanical irritation, we tried to find the iatrogenic factors that predispose @entity1 to @entity3361 during coronary angiography. METHODS: Retrospectively, we reviewed the records of 7,295 @entity1 who underwent coronary angiography at our hospital from June, 1983 to November, 1997; @entity3361 was documented in 30 @entity1 , who became the study group. We randomly selected 41 @entity1 who had normal coronary arteries as the normal control group. After reviewing cine films of coronary angiography, we compared these two groups for several parameters. These parameters included the length and diameter of the left main coronary artery (LMC), the angle between the LMC and the aorta, the angle between the catheter tip and the LMC, whether the catheter tip came into contact with the vascular wall and whether there was vessel wall bulging, catheter size and catheter/LMC ratio. This angiographic data and the demographic features, including age, sex, history of @entity101 , @entity6 , smoking, previous @entity583 , family history of @entity453 , @entity165 and @entity412 levels and @entity662 character (exertional or @entity158 ) were compared between the study @entity1 group and the control group. RESULTS: The results disclosed that larger catheter size (7.1 +/- 0.6 mm vs 6.4 +/- 0.7 mm, p < 0.001), smaller LMC diameter (4.2 +/- 0.9 mm vs 4.9 +/- 1.0 mm, p = 0.004), larger catheter/LMC ratio (0.07 +/- 0.05 vs 0.05 +/- 0.03, p = 0.022), catheter contact with the vessel wall (27/30 vs 20/41, p < 0.001) and vessel bulging (18/30 vs 5/41, p < 0.001) were related to catheter-induced @entity3361 . We found that the catheter tip coming into contact with the vessel wall, vessel wall bulging and catheter/LMC ratio (odds ratio 8.92 x 10(14)) were statistically significant factors predisposing @entity1 to catheter-induced @entity3361 . CONCLUSIONS: Multiple factors contribute to @entity3361 . Of those, mechanical or iatrogenic factors might predispose @entity1 to @entity2473 during coronary catheterization. These facts deserve our attention, because iatrogenically induced @entity2473 may be avoided by meticulously selecting catheters and manipulating them gently.
