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(A) Jacky Optitorque catheter (Terumo Interventional Systems) is ideal for radial access procedures, because its shape enables both left and right coronary entry without the need for catheter exchanges. (B) The specialized handmodified Jacky-Like catheter modified from diagnostic 5F Left-Judkins 3.5 catheter is used as a single dual-purpose catheter during transradial coronary angiography.
Source publication
Objective:
To investigate safety and efficacy of specialized hand-modified "Jacky-Like" catheter (JLC) as a single dual-purpose catheter in transradial coronary angiography.
Methods:
Patients over 18 years undergoing diagnostic CAG through right radial artery (RRA) were prospectively enrolled. Procedures were performed with a single JLC modified...
Context in source publication
Context 1
... extension was then inserted with a shaped dilatator. To prevent arterial spasm, 200 mcg of nitroglycerine was administered through the sideport, and 5,000 IU of heparin was given as an intraarterial bolus. In 2C group, standard 5F JL3.5 and JR4.0 catheters were used. Hand-modified JLC modified from JL3.5 was used in the single-catheter approach (Fig. 1). The interventions showing how 5F JLC catheter was modified from 5F JL3.5 catheter are summarized in Figure 2. Two interventional cardiologists, who use radial route as default arterial access site and perform more than 500 transradial procedures annually, performed the procedures. A standard J-curve 0.035 guidewire was used for the ...
Citations
... More spasm occurred in the dual catheter group. In the study of Erden et al. [15], JL 3.5 catheter shaped like a Jacky catheter was used in the single catheter group, and standard JL 3.5 and JR 4 catheters were used in the dual catheter group. The need for additional catheters was higher in the single catheter group. ...
Objectives: The aim of this study was to assess the safety and efficacy of single Judkins left (JL) catheter to view right and left coronary artery in right transradial coronary angiography. Methods: A total of 266 patients underwent coronary angiography from the right radial artery were studied prospectively. Patients with ad-hoc percutaneous coronary intervention (PCI), peripheral angiography, ventriculography or aortography procedures (67 patients) were excluded from the study. Coronary angiography was performed with the JL catheter as single catheter group in 171 of the remaining 199 patients, and with the Judkins right and left catheters as the control group in the other 28 patients. Complications, procedure success, procedure time and fluoroscopy time were evaluated between the two groups. Results: Procedure success were 93% (159/171) in patients with a single catheter group and 96.4% (27/28) in patients with two catheter (Judkins right and left) group (control group) (p = 0.49). Complications (spasm) are the same between the two groups (8 of 171 [4.7%] patients in study group and 1 of 28 [3.6%] patients in control group, p = 0.79). Fluroscopy time in single JL catheter group was significantly higher (6.20 ± 4.97 min vs 3.76 ± 2.78 min, p = 0.01). Conclusions: Single JL catheter using to view right and left coronary artery in right transradial coronary angiography was safe and effective. In our study, the success rate of getting left and right coronary artery images with a single JL catheter as high as 93%. However, insisting on imaging with a single catheter extends the duration of fluoroscopy time.
... In recent years, multiple studies have been published about the benefits of the one-catheter strategy, highlighting greater benefit in observational studies [8][9][10][11] than in controlled studies [12][13][14][15][16] , which may entail a bias in the perception of the real benefits of this strategy, especially regarding radiological contrast saving. However, to date there are no studies that integrate the information derived from randomized clinical trials (RCT) to adequately quantify the advantages of the one-catheter strategy. ...
... It is noteworthy that three RCT comparing one versus two-catheter strategy were not included for the final analysis because one article did not inform about the primary endpoint of the study (volume of contrast administered) 20 and two articles were not written in English language 21,22 (Fig. 1). Finally, five studies met the inclusion criteria [12][13][14][15][16] . ...
... Regarding to the total volume of contrast used, all five studies [12][13][14][15][16] were used for the pooled analysis. A significant difference was observed in the total volume of contrast administered favorable to one-catheter strategy (DiM [95% CI]; −3.831 mL [−6.165 mL-−1.496 ...
... The differences observed in previous trial designs may hinder the interpretation of our results. [9][10][11][12] Kim et al performed the first randomized comparison between these catheters in 160 stable patients, demonstrating shorter fluoroscopy time with Tiger II catheter, but without recording differences in direct radiation measurements such as air kerma (AK) or dose-area product (DAP). 9 Later, Xantopoulou et al, investigating the use of iodine contrast volume, confirmed as a secondary outcome that Tiger II catheter use resulted in a relative reduction in mean fluoroscopy time of 10.3% compared with multiple Judkins catheters. ...
... Previous analyses with single-catheter techniques (Tiger II and "Jack like" catheter) also observed, almost homogeneously, a marked reduction in the fluoroscopy time when compared with the use of Judkins catheters. [9][10][11][12][13]15 The average reduction of 13 seconds observed in the fluoroscopy time in favor of the Tiger II may impact clinical practice in labs with a high volume of CAG procedures, such as those with fellowship training programs in interventional cardiology, due to the longer learning curve of transradial procedures. In the REVERE trial, the major independent predictors of radiation load (AK) were: the number of recordings (image acquisitions); the operator's experience; and the number of catheters needed to complete the procedure. ...
Background:
In high-expertise transradial (TR) centers, the radiation exposure to patients during coronary angiography (CAG) is equivalent to transfemoral use. However, there is no definitive information during TR-CAG regarding the use of a single, dedicated catheter to impart less radiation exposure to patients.
Objective:
We compare the radiation exposure to patients during right TR-CAG with Tiger II catheter (Terumo Interventional Systems) vs Judkins right (JR) 4.0/Judkins left (JL) 3.5 catheters (Cordis Corporation).
Methods:
This multicenter, randomized, and prospective trial included 180 patients submitted to right TR-CAG, with the primary objective of observing radiation exposure to patients through the measurement of fluoroscopy time, air kerma (AK), and dose-area product (DAP) using Tiger II (group 1) vs JR 4.0 and JL 3.5 Judkins catheters (group 2). Secondary outcomes included contrast volume usage and the need to use additional catheters to complete the procedure (the crossover technique).
Results:
Group 1 demonstrated reduced fluoroscopy time (2.47 ± 1.05 minutes in group 1 vs 2.68 ± 1.26 minutes in group 2; P=.01) and non-significant reduction of AK (540.9 ± 225.3 mGy in group 1 vs 577.9 ± 240.1 mGy in group 2; P=.34) and DAP (3786.7 ± 1731.7 μGy•m² in group 1 vs 4058.0 ± 1735.4 μGy•m² in group 2; P=.12). Contrast volume usage (53.46 ± 10.09 mL in group 1 vs 55.98 ± 10.43 mL in group 2; P=.13) and the need for additional catheters (5.56% in group 1 vs 4.44% in group 2; P>.99) were similar between groups.
Conclusion:
The Tiger II catheter was able to reduce radiation exposure to patients submitted to TR-CAG through a significant reduction in fluoroscopy time.
... In recent years, multiple studies have been published about the benefits of the one-catheter strategy, highlighting greater benefit in observational studies [8][9][10][11] than in controlled studies [12][13][14][15][16] , which may entail a bias in the perception of the real benefits of this strategy, especially regarding radiological contrast saving. However, to date there are no studies that integrate the information derived from randomized clinical trials (RCT) to adequately quantify the advantages of the one-catheter strategy. ...
... It is noteworthy that three RCT comparing one versus two-catheter strategy were not included for the final analysis because one article did not inform about the primary endpoint of the study (volume of contrast administered) 20 and two articles were not written in English language 21,22 (Fig. 1). Finally, five studies met the inclusion criteria [12][13][14][15][16] . ...
... Regarding to the total volume of contrast used, all five studies [12][13][14][15][16] were used for the pooled analysis. A significant difference was observed in the total volume of contrast administered favorable to one-catheter strategy (DiM [95% CI]; −3.831 mL [−6.165 mL-−1.496 ...
Background:
One-catheter strategy, based in multipurpose catheters, allows exploring both coronary arteries with a single catheter. This strategy could simplify coronary catheterization and reduce the volume of contrast administration, by reducing radial spasm. To date, observational studies showed greater benefits regarding contrast consumption and catheterization performance than controlled trials. The aim of this work is to perform the first systematic review and meta-analysis of randomized clinical trials (RCT) to adequately quantify the benefits of one-catheter strategy, with multipurpose catheters, over conventional two-catheter strategy on contrast consumption, and catheterization performance.
Methods:
A search in PubMed, CINALH, and CENTRAL databases was conducted to identify randomized trials comparing one-catheter and two-catheter strategies. The primary outcome was volume of iodinated contrast administrated. Secondary endpoints, evaluating coronary catheterization performance included: arterial spasm, fluoroscopy time, and procedural time.
Results:
Five RCT were included for the final analysis, with a total of 1599 patients (802 patients with one-catheter strategy and 797 patients with two-catheter strategy). One-catheter strategy required less administration of radiological contrast (difference in means [DiM] [95% confidence interval (CI)]; -3.831 mL [-6.165 mL to -1.496 mL], p = 0.001) as compared to two-catheter strategy. Furthermore, less radial spasm (odds ratio [95% CI], 0.484 [0.363 to 0.644], p < 0.001) and less procedural time (DiM [95% CI], -72.471 s [-99.694 s to -45.249 s], p < 0.001) were observed in one-catheter strategy. No differences on fluoroscopy time were observed.
Conclusions:
One-catheter strategy induces a minimal reduction on radiological contrast administration but improves coronary catheterization performance by reducing arterial spasm and procedural time as compared to conventional two-catheter strategy.
... A estratégia de um cateter para procedimentos de diagnóstico coronariano radial pode ajudar a reduzir o espasmo radial, as complicações relacionadas à administração de contraste e a exposição à radiação ionizante, uma vez que evita a troca de cateteres angiográficos durante procedimentos coronarianos. [4][5][6][7][8] Entretanto, apesar dos possíveis benefícios, a estratégia de um cateter para a cineangiocoronariografia por acesso transradial não é rotineiramente usada em diversos centros. Entre outros fatores, isso pode ser justificado pela necessidade de os operadores realizarem a curva de aprendizado ou à escassez de dados sobre seu impacto no desempenho do cateterismo e nos custos econômicos. ...
... Esses resultados estão de acordo com três dos mais recentes ensaios clínicos randomizados, demonstrando uma redução no espasmo radial pela estratégia de um cateter. 7,18,19 Diversos fatores, como idade, sexo feminino, múltiplas punções radiais e diâmetro radial, estão relacionados ao espasmo radial. 4,[14][15][16]20 Além disso, a troca de cateteres durante o acesso pela via radial tem estado associada à indução de espasmo radial, provavelmente relacionada à repetida estimulação da artéria radial. ...
Background:
Coronary angiography with two catheters is the traditional strategy for diagnostic coronary procedures. TIG I catheter permits to cannulate both coronary arteries, avoiding exchanging catheters during coronary angiography by transradial access.
Objective:
The aim of this study is to evaluate the impact of one-catheter strategy, by avoiding catheter exchange, on coronary catheterization performance and economic costs.
Methods:
Transradial coronary diagnostic procedures conducted from January 2013 to June 2017 were collected. One-catheter strategy (TIG I catheter) and two-catheter strategy (left and right Judkins catheters) were compared. The volume of iodinated contrast administered was the primary endpoint. Secondary endpoints included radial spasm, procedural duration (fluoroscopy time) and exposure to ionizing radiation (dose-area product and air kerma). Direct economic costs were also evaluated. For statistical analyses, two-tailed p-values < 0.05 were considered statistically significant.
Results:
From a total of 1,953 procedures in 1,829 patients, 252 procedures were assigned to one-catheter strategy and 1,701 procedures to two-catheter strategy. There were no differences in baseline characteristics between the groups. One-catheter strategy required less iodinated contrast [primary endpoint; (60-105)-mL vs. 92 (64-120)-mL; p < 0.001] than the two-catheter strategy. Also, the one-catheter group presented less radial spasm (5.2% vs. 9.3%, p = 0.022) and shorter fluoroscopy time [3.9 (2.2-8.0)-min vs. 4.8 (2.9-8.3)-min, p = 0.001] and saved costs [149 (140-160)-€/procedure vs. 171 (160-183)-€/procedure; p < 0.001]. No differences in dose-area product and air kerma were detected between the groups.
Conclusions:
One-catheter strategy, with TIG I catheter, improves coronary catheterization performance and reduces economic costs compared to traditional two-catheter strategy in patients referred for coronary angiography.
... Universal TRA catheters allow single-pass access to the RCA and LCA and may result in shorter fluoroscopy time and shorter procedure time in comparison with dedicated catheters. [9][10][11][12] However, use of universal catheters may also require catheter or access-site changes in certain patients and subsequently increase procedure time and radiation exposure when compared with dedicated catheters. [12][13][14] The aim of this study is to identify which patient-related characteristics may a priori identify patients who are less likely to undergo a diagnostic invasive coronary angiogram with a universal catheter alone and require exchange to an alternative dedicated catheter. ...
... [9][10][11][12] However, use of universal catheters may also require catheter or access-site changes in certain patients and subsequently increase procedure time and radiation exposure when compared with dedicated catheters. [12][13][14] The aim of this study is to identify which patient-related characteristics may a priori identify patients who are less likely to undergo a diagnostic invasive coronary angiogram with a universal catheter alone and require exchange to an alternative dedicated catheter. Identification of these factors may allow better patient selection for the universal-catheter versus dedicated-catheter strategy in TRA and increase the procedure success rate without an increase in procedure time or radiation exposure. ...
... 9 Several larger randomized studies of patients undergoing TRA diagnostic coronary angiography also demonstrated shorter procedure time, shorter fluoroscopy time, and lower rate of severe radial artery spasm with a universal versus dualcatheter strategy. [10][11][12] However, at least one recent large randomized trial demonstrated longer procedure and fluoroscopy times, suggesting that the benefits of universal catheter use during TRA coronary angiography are not con-sistent. 14 Furthermore, several of these studies also demonstrated greater use of supplemental catheters and higher rates of crossover or failure to complete coronary angiography with a universal catheter alone. ...
Background:
Use of a universal diagnostic catheter may decrease procedural time and catheter-exchange related spasm when compared with a dual-catheter strategy. The aim of this study was to identify preprocedural predictors of failure to complete a coronary angiogram with a universal catheter alone.
Methods:
Consecutive patients (n = 782) who underwent a right transradial/transulnar coronary angiogram with a single operator were retrospectively reviewed. Multivariable predictors of failure to complete the procedure with a universal catheter alone were identified using logistic regression analysis and presented as odds ratio (OR) and 95% confidence interval (CI).
Results:
Of the study population (n = 558), a total of 216 (38.7%) required exchange to a coronary-specific catheter (44.4% for right coronary artery alone, 25.5% for left coronary artery alone, 30.1% for both) and 342 (61.3%) underwent angiography with a universal catheter alone. Patients who required a catheter exchange were more likely to have the following characteristics compared with patients who underwent an angiogram with a universal catheter alone: age >75 years (27.3% vs 16.4%; P<.01), female sex (34.3% vs 23.1%; P<.01), diabetes mellitus (50.0% vs 38.3%; P<.01), hypertension (88.0% vs 74.6%; P<.001), and chronic kidney disease (29.2% vs 17.8%; P<.01). After multivariable adjustment, age ≫75 years (OR, 1.92; 95% CI, 1.21-3.04), female sex (OR, 1.94; 95% CI, 1.20-3.14), hypertension (OR, 2.08; 95% CI, 1.22-3.57), and chronic kidney disease (OR, 1.58; 95% CI, 1.01-2.46) predicted failure of a universal catheter alone to complete angiography.
Conclusion:
Consideration may be given to use an initial dual-catheter strategy if one or more of the following are present: elderly age, female sex, hypertension, and chronic kidney disease.
... The electronic search identified 7 trials, all with full-length articles, 5,7,8,[14][15][16][17] (n = 978) or single-catheter strategy (n = 1,084; Supporting Information Figure S1). ...
... Several randomized trials investigated the performance of either standard Judkins-shaped or dedicated catheters for transradial coronary angiography. 5,7,8,[14][15][16][17] In principle, these latter should be timesaving by avoiding repeat insertion of catheters and might concur at reducing the risk of spasm and/or occlusion through less injury of RA. 4 However, as accumulated evidence does not consistently favor one strategy over another, we performed a meta-analysis of randomized trials, which assigned ≈2,000 patients either to dual-or singlecatheter strategies for transradial coronary angiography. The present analysis was based on the intention-to-treat principle and crossovers ...
... 20 Consistent with these findings, all trials included in this analysis graded the stability of single catheters during coronary angiography as inadequate in comparison to that of standard catheters. 5,7,8,[14][15][16][17] This mechanical behavior, which leads to unselective injection of contrast medium, incomplete filling of coronary arteries and poor image quality, is likely to counterbalance any potential advantage of single-catheter strategy. ...
Objectives
We sought to compare the procedural and clinical performance of dual‐ versus single‐catheter strategy for transradial coronary angiography.
Background
The radial artery (RA) is recommended as the vascular access of choice in patients undergoing coronary angiography and intervention. The procedural and clinical performance of dual‐ versus single‐catheter strategy in patients undergoing transradial coronary angiography remains a matter of debate.
Methods
This is a study‐level meta‐analysis of randomized trials. The primary outcome was procedure time. The main secondary outcome was fluoroscopy time. Other outcomes of interest were contrast volume, crossover to other catheter strategy and RA spasm.
Results
A total of 2,062 patients (978 randomly assigned to dual‐catheter and 1,084 to single‐catheter strategy) included in seven trials were available for the quantitative synthesis. A dual‐catheter strategy was associated with procedure time (standardized mean difference [95% confidence intervals (CI)], 0.55 [−0.69, 1.78]; p = .32), fluoroscopy time (−0.36 [−2.39, 1.67]; p = .68) and contrast volume (−0.93 [−3.79, 1.94]; p = .44) comparable to a single‐catheter strategy. The risk for crossover was lower (risk ratio [95% CI], 0.14 [0.03, 0.70]; p = .025) while the risk for RA spasm was higher (1.81 [1.54, 2.12]; p < .001) among patients assigned to dual‐ versus single‐catheter strategy.
Conclusions
This meta‐analysis provides evidence for a comparable procedural performance of either dual‐ or single‐catheter strategy for transradial coronary angiography. The fewer crossovers with dual‐catheter strategy occur at the expense of more frequent radial artery spasm.
... The electronic search identified 7 trials, all with full-length articles, 5,7,8,[14][15][16][17] (n = 978) or single-catheter strategy (n = 1,084; Supporting Information Figure S1). ...
... Several randomized trials investigated the performance of either standard Judkins-shaped or dedicated catheters for transradial coronary angiography. 5,7,8,[14][15][16][17] In principle, these latter should be timesaving by avoiding repeat insertion of catheters and might concur at reducing the risk of spasm and/or occlusion through less injury of RA. 4 However, as accumulated evidence does not consistently favor one strategy over another, we performed a meta-analysis of randomized trials, which assigned ≈2,000 patients either to dual-or singlecatheter strategies for transradial coronary angiography. The present analysis was based on the intention-to-treat principle and crossovers ...
... 20 Consistent with these findings, all trials included in this analysis graded the stability of single catheters during coronary angiography as inadequate in comparison to that of standard catheters. 5,7,8,[14][15][16][17] This mechanical behavior, which leads to unselective injection of contrast medium, incomplete filling of coronary arteries and poor image quality, is likely to counterbalance any potential advantage of single-catheter strategy. ...
Objectives:
We sought to compare the procedural and clinical performance of dual- versus single-catheter strategy for transradial coronary angiography.
Background:
The radial artery (RA) is recommended as the vascular access of choice in patients undergoing coronary angiography and intervention. The procedural and clinical performance of dual- versus single-catheter strategy in patients undergoing transradial coronary angiography remains a matter of debate.
Methods:
This is a study-level meta-analysis of randomized trials. The primary outcome was procedure time. The main secondary outcome was fluoroscopy time. Other outcomes of interest were contrast volume, crossover to other catheter strategy and RA spasm.
Results:
A total of 2,062 patients (978 randomly assigned to dual-catheter and 1,084 to single-catheter strategy) included in seven trials were available for the quantitative synthesis. A dual-catheter strategy was associated with procedure time (standardized mean difference [95% confidence intervals (CI)], 0.55 [-0.69, 1.78]; p = .32), fluoroscopy time (-0.36 [-2.39, 1.67]; p = .68) and contrast volume (-0.93 [-3.79, 1.94]; p = .44) comparable to a single-catheter strategy. The risk for crossover was lower (risk ratio [95% CI], 0.14 [0.03, 0.70]; p = .025) while the risk for RA spasm was higher (1.81 [1.54, 2.12]; p < .001) among patients assigned to dual- versus single-catheter strategy.
Conclusions:
This meta-analysis provides evidence for a comparable procedural performance of either dual- or single-catheter strategy for transradial coronary angiography. The fewer crossovers with dual-catheter strategy occur at the expense of more frequent radial artery spasm.
... LIMA can then be displayed with several rotation movements. In anomalous cases, if we cannot engage grafts with existing catheters, we were able to achieve imaging by catheter reshaping in the laboratory environment [17][18][19] (Figure 3, Videos 1 and 2). ...
Objective:
Over the past 10 years, the rate of patients who have undergone coronary artery bypass graft (CABG) surgery has increased twofold in cases of coronary angiography. Today, transradial access is the first choice for coronary angiography. We aimed to compare the efficacy and reliability of radial versus femoral access for coronary angiography in post-CABG surgery in this study.
Methods:
Data from 442 patients who underwent post-CABG surgery between 2012-2017 were retrospectively compared. The right radial route was used in 120 cases, the left radial route in 148, and femoral route in 174. These three pathways were compared in terms of procedure time and fluoroscopy time, efficacy, and complication development. Comparisons among the three groups were performed with Bonferroni test for continuous variables and chi-square or Fisher's exact test for nominal variables as a binary.
Results:
Comparison results indicate that femoral access was better than left radial access and the left radial access was better than right radial access in terms of fluoroscopy time (10.71±1.65, 10.94±1.25, 16.12±5.28 min, P<0.001) and total procedure time (17.28±1.68, 17.68±2.34, 23.04±5.84 min, P<0.001). The left radial pathway was the most effective way of viewing left internal mammary artery (LIMA). No statistically significant differences were found among the three groups in other graft visualizations, all minor complications, total procedure and fluoroscopy time "Except LIMA imaging". Mortality due to processing was not observed in all three groups.
Conclusion:
The left radial route is preferred over right radial access for post-CABG angiography because the left radial pathway is close to the LIMA and is similar to the femoral pathway. In LIMA graft imaging, right radial access is a reliable route, even though it is not as effective as other pathways. We hope that the right radial pathway will improve with physician experience and innovations.
... A Simmons, CK1 (Berenstein interventional neuroradiology catheter); HN2, HN4, HN5 (Newton catheters); Vitek (interventional neurology catheter); or MAN (Mani catheter) catheter may be preferred for interventional purposes during carotid angiography. [7][8][9][10][11] However, these types of catheter are not used often and may only be supplied on demand and therefore not al-ways available in most coronary angiography laboratories. Consequently, reshaping existing catheters may be useful for imaging anomalous vessels, or performing carotid or peripheral artery angiographies (Fig. 1). ...
... We suppose that catheter reshaping is performed in many angiography laboratories, but there are few studies on the subject. [7][8][9] Similar studies will enhance our knowledge and experience of angiography and contribute to the development of the procedure. All invasive procedure experiences open new areas for percutaneous interventions. ...
Background:
We have evaluated the feasibility of concomitant carotid angiography after coronary angiography with the same catheter, and the practicality, safety and success of image acquisition with respect to conventional catheters.
Method:
248 patients have been enrolled in the study, who have been evaluated with both carotid and coronary angiography in a time period between 2010 and 2017. 117 of them were evaluated with right diagnostic catheters and 131 of them were evaluated with handmade S shaped (HMS) catheters. Basic parameters were similar in both of the groups. Total procedural time (7.34 ± 1.10 vs 9.56 ± 3.59 minutes, p < 0.001), fluoroscopy use time (6.08 ± 1.72 vs 5.23 ± 1.00 minutes, p < 0.001), used contrast media volume (50.2 ± 15.6 mL vs 62.3 ± 17.9 mL, p < 0.001) were all lower in the HMS catheter group.
Conclusion:
There is strong correlation between coronary and carotid artery disease (62%). Many Cardiologists perform concomitant carotid angiography when performing coronary angiography using right diagnostic catheters (JR). The JR catheters tip can be reshaped like to S to enhance its safety and efficacy during carotid imaging. Our experience supports this. Imaging of the carotid arteries is advantageous for the patients with severe coronary artery disease, when performing coronary angiography. For this purpose, the same catheter used for coronary imaging can be used after it is reshaped at hand, in place of a special catheter. This method is both efficient and safe.
