Author + information
- Purich Surunchupakorn1
Patient initials or identifier number
Relevant clinical history and physical exam
A 51 years old male was presented with exertional chest pain for 3 mos.
His risk factors included hypertension, dyslipidemia.
PE : BP 130/80 HR 80 bpm
H&L : WNL
Radial artery : Rt 2+ Lt 2+ Good femoral and dorsalis pedis pulse both
Relevant test results prior to catheterization
Echo was shown good LVEF without RWMA
EST was shown positive at moderate workload (3 mins.)
Relevant catheterization findings
Transradial approach using 6Fr sheath with 6Fr JR4.0 diagnostic catheter and 6Fr JL4.0 diagnostic catheter
CAG (RCA dominant)
LM, LAD : Normal ,unobstructed
LCx/OM : 70-80% diffuse stenosis
RCA : Subtotal occlusion at mid RCA
So I desired to Adhoc PCI to RCA first using JR4.0 guiding catheter, but after I was push catheter to Rt radial artery it was obstructed.Then, I recheck right radial artery again and was shown to be dissection and perforation. Pressure from right radial artery was going down to no pressure and patient was in pain. So I desired to do parallel wire with 0.014 workhorse wire (because 0.035″ still in the true lumen), which was difficult.And used 2.0 x 15 semi compliance balloon inflate at 6 atm to support JR guiding catheter (Balloon-assisted tracking technique) and then slowly push guiding catheter with the balloon up on right radial artery. After passed guiding catheter to ascending aorta, JR4.0 catheter was engaged then I continue to do PCI using fine cross and fielderXT, predilate and stent RCA. After I was finished PCI to RCA, I have rechecked RCA again and seen that radial A dissection and perforation were healed by guiding catheter. This also happened when I have scheduled him for PCI to LCx next time also.
A Complications due to PCI transradial are sometimes crucial.
An Aggressive push catheter while radial artery spasm or small radial artery caliber are very harmful to cause radial artery dissection and perforation. Balloon assisted tracking technique is very useful and convenient technique to bailout this situation. A Guiding catheter can be used to seal radial artery dissection and perforation.
(Actually, this also happen the 2nd time I appoint him to do PCI to LCx again, next procedure).