Tiger Catheter for Difficult Femoral Artery Approach Coronary Catheterization
Authors: Nimmagadda Satya Sudhish , Shafi P. , Devalkar Ashish , Malladi Srinivasa Rao , Vajhala Adilakshmi Bhairava 
Published: April 2024

Background:
While most catheters are designed for the natural anatomy of the coronaries at the origin, we often end up using multiple catheters in failed attempts to hook the coronary ostia in case of unusual origins. We had similar issues where we used multiple catheters in vain during femoral approach catheterizations and ended up successfully hooking with a tiger (TIG) catheter in a few of our cases in the catheterization laboratory. We mostly used Judkins left (JL) and Judkins right (JR) catheters as the first choice for femoral approach catheterizations. Hence, we wanted to see how frequently we had to use catheters other than JL and JR and which catheter was most useful in such cases.

Methods:
This is a retrospective study of catheterization laboratory angiographic data and recordings involving femoral artery approach coronary catheterization at King George Hospital, Visakhapatnam, from January 2022 to December 2022. We analyzed and interpreted the data of difficult femoral artery catheterizations where JL/JR catheters could not hook the coronaries successfully. We tabulated such data in percentages to understand which catheter was most useful in such cases. We analyzed the angiograms of such cases to understand the coronary origins.

Results:
Overall, 1130 cases underwent femoral artery approach coronary angiograms. Of them, 1100 (97.3%) cases could be hooked with JL and JR catheters. Thirty (2.65%) cases were found to be difficult femoral artery approach catheterizations where either JL or JR catheter could not be used successfully. Out of those difficult ones (30 cases – 100%), 22 (73.3%) cases could be hooked with TIG catheter, 4 (13.33%) cases with extra backup (EBU) catheter, 1 (3.33%) case with JR side hole (JRSH) catheter, 2 (6.66%) cases with no torque right (NTR) catheter, and 1 (3.33%) case with multipurpose catheter (MPA). Out of these 30 cases, a left coronary angiogram was needed other than a JL catheter in 8 cases, while a right coronary angiogram was needed other than a JR catheter in 25 cases, showing that the right coronary artery (RCA) was mostly involved in difficult catheterizations. For left coronary angiograms, 4 cases hooked with TIG (1 case – posteriorly/low takeoff, 1 – high takeoff, 1 – mid-takeoff, and 1 – RCA/left main coronary artery [LMCA] from left sinus) and 4 cases with EBU catheter (1 – anterior/high takeoff, 2 – high takeoffs, and 1 – posteriorly/high takeoff). For right coronary angiograms, 21 cases hooked with TIG (3 cases – left sinus/anteriorly, 3 – high takeoff/anteriorly, 3 – low takeoff, 2 – mid takeoff/anteriorly, 3 – posterior/high takeoff, 1 – RCA/LMCA from left sinus, 1 – posteriorly/left sinus, 3 – high takeoff, 1 – anteriorly/low takeoff, and 1 – right sinus/mid-takeoff), 1 case with JRSH, 1 case with MPA (anterior/high takeoff) and 2 cases with NTR (1 – low takeoff and 1 – high takeoff).

Conclusion:
We found that the TIG catheter was useful in difficult femoral approach catheterizations in the majority of cases and it can be tried in difficult cases.