Histologic evidence of angiographic catheter-induced vascular trauma: a comparison of conventional and deformable soft-tip catheters.

Catheter-related complications associated with coronary arteriography remain an iatrogenic hazard with life-threatening consequences. Because such complications may be related to catheter-tip-induced vascular trauma during coronary angiography or percutaneous transluminal coronary angioplasty (PTCA), several types of deformable, soft-tip angiographic catheters have been developed. The following study was undertaken to evaluate the effects of one of these catheters, as well as of conventional catheters, in canine arteries. Ten dogs were catheterized, five with a conventional angiographic catheter and five with a deformable soft-tip catheter (Angiomedics SOFTIP model), all in the Judkins left 3.5 configuration. The left coronary artery (LCA) was subjected to repeated catheterization; the instruments were also advanced and withdrawn through various segments of the thoracic and abdominal aorta and the right iliac artery. Forty-five arterial tissue sections were collected; these were subjected to histologic analysis 2 weeks after catheterization. When catheterized with the soft-tip instrument, muscular arteries such as the LCA and the right iliac artery had an 86% reduction in subintimal lesions with a disrupted or split internal elastic membrane, compared to muscular arteries catheterized with a conventional instrument (p <.017). Moreover, two medial tears were produced by the conventional catheters. On a scale of 1 to 3 (3 being the most severe), the average severity of muscular arterial lesions observed after use of the soft-tip catheter was 1.0, whereas the average severity associated with conventional catheters was 2.0 (p <.02). No significant differences were observed in elastic (aortic) segments. Therefore, this study showed that subacute, subintimal vascular lesions induced by conventional angiographic catheters are more frequent, more serious, and more likely to penetrate the internal elastic membrane than are lesions produced by soft-tip catheters. Obviously, then, soft-tip catheters offer a safer, less traumatic approach to diagnostic and interventional cardiology.