Straightening a Radial Artery Loop

To attempt to straighten a radial artery loop, pressure can be applied to the arm above the antecubital space with the hand. Then simultaneously pull caudal on the wire, and squeeze and push cranial with the other hand. A few tips to overcome the radial loop:

1) Take a picture. Have a low threshold to perform radial angiography and visualize the anatomy. 

2) Change the wire. Use of an 0.014-inch or 0.025-inch wire +/- a buddy wire may facilitate crossing of the loop. Hydrophilic wires may be easier to use, but caution must be used to avoid dissection. Additionally, repeated attempts to cross with a 0.035-inch wire or stiffer, small wire could potentially result in spasm, perforation, or patient pain.³

3) Straighten the loop. This can usually be achieved by advancing the wire as far toward the ascending aorta as possible and then retracting the system. Apply pressure to the arm above the antecubital space with the hand and then simultaneously pull caudal on the wire and squeeze and push cranial with the other hand.

4) Adjunctive techniques. Consider use of BAT (balloon-assisted tracking) to facilitate crossing.⁴ During BAT, a partially inflated balloon protrudes through the catheter tip to minimize trauma in crossing. In addition, use of a low-profile crossing catheter may be easier than using a coronary catheter to cross. The Quick-Cross (Spectranetics) and CXI (Cook) are used in our lab to cross the loop over two 0.014-inch wires and then exchanged for the 0.035-inch wire.

Comment regarding the fluoroscopic video from Dr. Zaheed Tai:

Related: "Navigating a Radial Loop"