Radial catheterization pitfalls
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hesham Bahaa El-Din, M.B.B.Ch., M.Sc.
Overview
The data that had been published up till now entails an incidence of about 2% to 34% of radial artery spasm, which would result in transfemoral approach being used instead. [1]. So some precautions should be made beforehand in anticipation of such complications.
Potential Pitfalls of the Radial Approach to Cardiac Catheterization
1- Radial artery spasm:-
- In order to decrease the incidence of radial artery spasm, some interventionist tend to give light sedation as well as intra-arterial Nitroglycerin and calcium channel blocker (verapamil or diltiazem) in order to relax the smooth muscles of the radial artery.
2- Vessel tortuosity. Some of the tortuous forms are:-
- Alpha shape radial artery.
- S-shaped radial artery.
- Proximal and distal omega shaped radial artery.
- Brachial alpha loop.
- High origin radial artery.
A lot of techniques has been used to overcome tortuosities. when a regular 0.35" J-wire is unable to cross the tortuous vessel, a PTCA 0.014" is used to cross this part. Then Balloon-Assisted Tracking (BAT) can be useful. It is a technique in which a small compliant balloon usually 2.0mm X 15.0 or 20.0 mm is inflated at the tip of the Guide-in catheter with half to one third of the balloon is inside the catheter. Balloon is inflated slightly over the nominal pressure, the catheter is then steered across the tortuous vessel over the PTCA wire. This technique can also be used in case of radial artery spasm.[2]
3- Guide catheter support and selection may be reduced.
4- Loss of radial artery pulse in 4% of cases.
5- Potential increase in the duration of the procedure and fluroscopy time
6- The radial artery has been instrumented should there be a desire to use it as a conduit for CABG
7- It is the second and not the first approach learned by trainees
8- There is a learning curve in treating spasm, navigating anatomy, and manipulating catheters
9- Anatomically there can be a loop in the artery near the brachial in about 10% of cases
10- Smaller sheaths are required (4-8F)
References
- ↑ Lapras C, Bret P, Capdeville J (1978). "[Diastematomyelia. About a series of 6 cases (author's transl)]". Neurochirurgie. 24 (6): 381–9. PMID 752811.
- ↑ Verouden NJ, Kiemeneij F (2014). "Balloon-Assisted Tracking to Overcome Radial Spasm during Transradial Coronary Angiography: A Case Report". Case Rep Cardiol. 2014: 214310. doi:10.1155/2014/214310. PMC 4008174. PMID 24826306.