Received October 7, 1 985; accepted after revision December 17, 1985. This work was supported in part by U.S. Public Health Service grants GM 1 8674 and HL 07334. ‘ Department of Radiology, Harvard Medical School, and Brigham and Women’s Hospital. 75 Francis St., Boston, MA 021 15. Address reprint requests to G. A. Gardiner. Jr. 2 Department of Medicine, Cardiovascular Division, Harvard Medical School, and Brigham and Women’s Hospital. Boston, MA 021 15. 83i AJR 146:831-833, April 1986 0361 -803x/86/1464-0831 C American Roentgen Ray Society Selective Coronary Angiography Using a Power Injector Geoffrey A. Gardiner, Jr.,1 Michael F. Meyerovitz,1 Lawrence M. Boxt,1 Donald P. Harrington,1 Richard H. Taus,1 Krishna Kandarpa,1 Peter Ganz,2 and Andrew P. Selwyn2 Selective coronary angiography plays a key role in the diagnosis and treatment of patients with coronary artery disease. Image quality may significantly affect interpretation of coronary angiograms [1 -3]. Poor quality examinations may result in incorrect patient management and expose the patient to considerable risk [4]. One of the most important factors contributing to high-quality images is dense, uniform opacifi- cation of the coronary arteries with contrast medium. We have noted in our own cases, and in cases from other institutions, considerable variability in coronary artery opaci- fication, not only from person to person, but also with each injection. In an attempt to obtain optimal opacification, we have recently begun to use a standard angiographic power injector for coronary artery injections. This has resulted in improved demonstration of the arteries, especially the left coronary artery, which commonly requires higher injection rates and volumes. Technique of Injection We use 7.3 French Judkins or Amplatz catheters capable of taking a 0.038 inch (0.097 cm) guide wire. Injections of up to 7 mI/sec may safely be made through end holes of this size [5]. A Medrad Mark IV power injector (Medrad, Pitts- burgh) is connected to a manifold via a high-pressure injection line and a three-way stopcock, the third port of which is connected to a syringe for test injections (fig. 1 ). Once the appropriate coronary artery has been engaged by the cathe- ter, we routinely make small test injections by hand to ensure good positioning of the catheter and the absence of a severe stenosis near the catheter tip. We are also careful to withdraw the left Judkins catheter slightly after engaging the left coro- nary artery to avoid pointing the end hole at the side wall of the artery [5]. Our standard injections range from 4 to 6 mI/ sec for a volume of 7-i 0 ml in the left coronary artery and 3 to 5 mI/sec for a total of 6-8 ml for the right coronary artery. The pressure limit of the power injector is set at 1 50 psi (10.4 kg/cm2). Using our system of catheter, manifold, and high- pressure injection line, injection rates of up to 6-7 mI/sec may be obtained depending on the catheter used. Each injection is monitored fluoroscopically. The injection rate and volume are varied depending on artery size and blood flow. Small arteries or arteries with severe stenoses require slower injection rates and smaller total volumes. Patients with myo- cardial hypertrophy from various causes such as aortic ste- nosis commonly require higher injection rates and slightly larger volumes. Evaluation of Injections One hundred four left coronary artery injections were per- formed in 23 patients. Only left coronary injections were compared in this study since these arteries are most likely to be poorly opacified. Fifty-five hand injections in 12 patients and 49 power injections in 1 1 patients were evaluated. Each coronary injection was graded by a blinded observer accord- Fig. 1 -Standard manifold used for coronary angiography with lines for pressure measurement (1), heparinized saline (2), and contrast medium (3). High-pressure injection line (arrow) from power injector is connected via three- way stopcock that also allows syringe to be connected to manifold for test injections of contrast material and flushing catheter. Downloaded from www.ajronline.org by 52.73.204.196 on 05/16/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved