Bigger Is Not Better In Catheter Use
To relieve the crushing pain caused by blockages in the heart, interventional cardiologists perform a variety of procedures, called percutaneous coronary interventions, to restore blood flow in diseased arteries.
But when it comes to choosing a catheter to reach those trouble spots in the arteries, bigger is not better.
A study led by the University of Michigan Health System showed patients who had coronary interventions, such as angioplasty, performed with larger catheters had significantly worse outcomes and higher death rates than those who underwent the procedures with smaller catheters. Results of the multi-hospital study will appear in the July 28 issue of the Journal of American College of Cardiology Cardiovascular Interventions.
Death rates were more than 30 percent higher in patients who had procedures with the larger 8F catheter than the smaller 6F catheter, according to the study produced by 31 Michigan hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
Other complications such as kidney damage, need for blood transfusions, and need for emergency open heart surgery were also significantly higher among patients who had the larger catheter.
“While overall death rates associated with PCIs are still low, the decision to use a smaller catheter significantly and independently increases the chance for patient survival and decreases the likelihood of other serious complications,” says lead author Paul Michael Grossman, M.D., assistant professor of internal medicine at the U-M Medical School and director of the VA Ann Arbor Cardiac Catheterization Laboratory.
With more than 103,000 patients observed at Michigan hospitals over five years, it’s one of the largest studies of its kind to look at catheter size and complications from PCI.
The findings could guide choices made by cardiac specialists and influence the development of devices designed to treat heart artery disease.
A variety of interventionists were part of the study that tracked the kinds of catheters used in PCIs. A PCI, sometimes referred to as balloon angioplasty or stenting, may be performed after rushing to the hospital following a heart attack, or as an elective surgery to unblock the artery before a heart attack occurs.
A PCI is done by threading a balloon-tipped tube – called a catheter – from the groin to an artery in the heart and the balloon inflated to compress a build-up of fats, cholesterol and plague that reduce blood flow, or block the artery completely. A metal stent is often left behind to prop up the artery like scaffolding.
Data gathered for the study shows some cardiologists in the group already prefer the smaller catheters because of their association with fewer vascular complications and quicker post-PCI recovery. However a significant number of interventionists use larger guide catheters because of perceived ease of use and the recommendation of some medical textbooks.