Abstract
We describe a case of radial artery occlusion caused by previous percutaneous coronary intervention. The occluded radial artery was opened through the distal radial artery, and left main coronary artery intervention was subsequently performed. Follow-up vascular ultrasound showed that the radial artery had smooth blood flow and no stenosis. (Level of Difficulty: Intermediate.)
Key Words: Doppler ultrasound, intravascular ultrasound, percutaneous coronary intervention
Graphical abstract
A 68-year-old woman was admitted to the hospital with increased chest pain frequency in the previous week. Coronary angiography had been performed 6 years earlier via the right radial artery. Electrocardiogram did not show ST-T segment changes. Her initial troponin I level and 3 subsequent tests were negative. The patient had a medical history of hypertension, type 2 diabetes mellitus, and hyperlipidemia. Echocardiography demonstrated a left ventricle ejection fraction of 62% with normal regional wall motion.
Coronary angiography was pursued. The right radial artery pulse was absent, but the distal radial artery pulse could be detected. A 6F Terumo vascular sheath was inserted into the right distal radial artery and angiography showed radial artery occlusion (Figure 1A). Using the knuckle technique, a Pilot 50 guidewire was inserted through the occluded segment to the brachial artery to verify the true lumen (Figure 1B, Video 1). Angiography showed severe stenosis of the radial artery (Figure 1C), which was sequentially dilated (Figure 1D) followed by left main intervention. Intravenous ultrasound examination of the radial artery showed that the walls of the proximal and distal radial arteries were smooth, and only a small segment of guide wire penetration of the inner membrane (Figure 1E). After coronary intervention, radial angiography showed that the stenosis of the radial artery was reversed. Two months after the procedure, the vascular ultrasound showed that the radial artery had normal blood flow with no stenosis (Figure 1F).
Figure 1.
Angiographic and Ultrasound Images
(A) Angiography showing radial artery occlusion. (B) A Pilot 50 guide wire inserted via the knuckle technique through the occlusion of the radial artery. (C) Radial arteriography showing severe stenosis of the radial artery. (D) Balloon dilation of the severe radial artery stenosis. (E) Intravenous ultrasound showing that the guide wire advanced into the true lumen, with the inner membrane and the false lumen visible. (F) Two-month post-procedure ultrasound showing that the radial artery had normal blood flow.
The incidence of vascular complications with radial artery access is significantly lower than with femoral artery access and earlier ambulation is possible (1); however, studies have shown that radial artery occlusion due to proximal radial artery puncture exceeds 5% (2). Our case proposes a method to open an occluded radial artery for subsequent coronary angiography.
Author Disclosures
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Footnotes
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.
Appendix
For a supplemental video, please see the online version of this paper.
Appendix
A Pilot 50 guide wire being inserted via the knuckle technique through the occlusion of the radial artery.
References
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Supplementary Materials
A Pilot 50 guide wire being inserted via the knuckle technique through the occlusion of the radial artery.