{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T14:40:31Z","timestamp":1747147231628,"version":"3.40.5"},"reference-count":13,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T00:00:00Z","timestamp":1611532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Assess the impact on fluoroscopy time and contrast use in patients with tortuous brachiocephalic\/thoracic aortas undergoing right transradial coronary angiography (RTCA) and provide strategies to manage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Unfavorable anatomy with severe brachiocephalic\/thoracic tortuosity, referred to as an \u201celephant head,\u201d remains a significant obstacle for RTCA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed the coronary angiograms of patients who underwent RTCA and had tortuous aortas. Angiography was attempted first using a universal catheter (Tiger) and switched to a left coronary specific catheter (Judkins Left [JL]) if challenging. Fluoroscopy time, contrast volume, and greatest distance from the patient's midline to the catheter in the aorta were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010nine patients (62.6\u2009\u00b1\u200912.0\u2009years, 69.4% male) were included. Fifteen (30.6%) patients underwent successful angiography with a Tiger catheter; 34 (69.4%) patients required switching to JL catheter. The average distance of Tiger catheters to the midline of the spine was 0.78\u2009\u00b1\u20090.41\u2009cm versus 1.28\u2009\u00b1\u20090.44\u2009cm (<jats:italic>p<\/jats:italic> = .001) in JL catheters. Tiger catheter use resulted in less fluoroscopy time (6.48\u2009\u00b1\u20094.73\u2009min) and contrast use (58.87\u2009\u00b1\u200943.53\u2009ml) than in cases switched to JL (13.26\u2009\u00b1\u200910.76\u2009min [<jats:italic>p<\/jats:italic> = .026]; 86.5\u2009\u00b1\u200969.95\u2009ml [(<jats:italic>p<\/jats:italic> = .017]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For patients undergoing RTCA with significant brachiocephalic\/thoracic aorta tortuosity, \u201celephant head,\u201d a Tiger catheter can be used efficiently for curvatures &lt;1 cm from the middle of the spine. We propose that for curvatures &gt;1 cm, operators should consider immediately switching to a JL catheter.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.29470","type":"journal-article","created":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T18:14:18Z","timestamp":1611598458000},"page":"418-423","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Right transradial coronary angiography in the setting of tortuous brachiocephalic\/thoracic aorta (\u201celephant head\u201d): Impact on fluoroscopy time and contrast use"],"prefix":"10.1002","volume":"99","author":[{"given":"Brian C.","family":"Case","sequence":"first","affiliation":[{"name":"Section of Interventional Cardiology MedStar Washington Hospital Center  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charan","family":"Yerasi","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology MedStar Washington Hospital Center  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian J.","family":"Forrestal","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology MedStar Washington Hospital Center  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chava","family":"Chezar\u2010Azerrad","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology MedStar Washington Hospital Center  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6099-0753","authenticated-orcid":false,"given":"Jaffar M.","family":"Khan","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology MedStar Washington Hospital Center  Washington District of Columbia"},{"name":"Cardiovascular Branch, Division of Intramural Research National Heart, Lung and Blood Institute, National Institutes of Health  Bethesda Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4159-555X","authenticated-orcid":false,"given":"Nauman","family":"Khalid","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology MedStar Washington Hospital Center  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0907-5258","authenticated-orcid":false,"given":"Evan","family":"Shlofmitz","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology MedStar Washington Hospital Center  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuefeng","family":"Chen","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology MedStar Washington Hospital Center  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anees","family":"Musallam","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology MedStar Washington Hospital Center  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4063-9226","authenticated-orcid":false,"given":"Ron","family":"Waksman","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology MedStar Washington Hospital Center  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hayder","family":"Hashim","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology MedStar Washington Hospital Center  Washington District of Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60404-2"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(99)70143-2"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJY15M11_05"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/joic.12157"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2011.10.019"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.23387"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.04.051"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/HCV.0000000000000035"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-17-00699"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.04.024"},{"key":"e_1_2_8_12_1","first-page":"269","article-title":"The higher cross\u2010over rate from Transradial to Transfemoral coronary angiography: do we have the explanation?","volume":"10","author":"Sallam M","year":"2010","journal-title":"Sultan Qaboos Univ Med J"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43044-019-0006-2"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2019.06.001"}],"container-title":["Catheterization and Cardiovascular 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