Selective Coronary Arteriography

In its evolution, coronary arteriography has passed through stages of initial exploratory opacifications in experimental animals, the development of various technics for coronary visualization, and their clinical trial to its present important position in the diagnosis and assessment of coronary artery disease. Interest in this procedure as a clinically useful tool is attested to by its inclusion in most current symposia concerned with overall considerations of coronary artery disease, and by the rapidly increasing number of medical centers applying coronary arteriography in clinical studies of this disorder. Historically, coronary arteriography dates from Rousthoi's (1) on angiocardiography in experimental animals, published in 1933, while Radner (2) in 1945 achieved the first opacification of coronary arteries in living man. A variety of technics for radiologic opacification of the coronary arteries has been studied and described (3–6), and the senior author has reviewed and discussed considerations of these in previous publications (5, 7–9). All appear to entail limitations or hazards, or to involve procedures sufficiently complex to render them less than ideal for wide adaptation. Direct radiopaque injection of the arterial system of an organ affords the optimal contrast visualization of its arterial supply, and selective arteriography has been adapted to a number of areas of human anatomy. In October of 1959, Sones (10) reported a technic of deliberate selective catheterization of coronary arteries with a specially designed catheter. His excellent cine studies and reported high incidence of success aroused great interest in the procedure. This report reviews our experience with selective coronary arteriography from April 1962 to October 1963. Methods and Materials The basic technic employed is that of Sones, with slight modification. To allay the patient's apprehension, intramuscular doses of Demerol 75 mg. and Vistaril 50 mg. (adults) are administered one hour prior to the procedure. Under local anesthesia, the brachial artery is exposed at the right antecubital fossa, well above its division into the radial and ulnar arteries. Arteriotomy is by a short (no longer than 1.0 mm.) transverse incision, which is slightly spread with fine, but blunt, curved eye forceps to facilitate catheter introduction. Any bleeding at the arteriotomy site is controlled by umbilical tape constriction of the vessel. We use Sones catheters 80 cm. long in either 7F or 8F size. This catheter tapers in its distal 5.0 cm. to size 5F, and has an end-hole as well as four oval side-holes in its distal 6.0 mm. It is important that the catheter have a very definite curve throughout the tapered distal portion. The tip is gently introduced into the arterial lumen and advanced under image-tube fluoroscopic control, with either mirror-system viewing or television monitoring.