Balloon Angioplasty of the Radial Artery to Solve a Challenging Radial Sheath Insertion

J INVASIVE CARDIOL 2021;33(1):E69. doi:10.25270/jic/20.00095

Key words: challenging radial sheath insertion, radial access preservation, radial artery balloon angioplasty

A 92-year-old male patient was scheduled for coronary angiography at our center because of an acute coronary syndrome. The right radial artery had good pulsatility, although the tactile feeling indicated a vessel with some small calcific nodules resembling rosary beads. After puncture, the 0.021˝ dedicated wire of the 6 Fr transradial Glidesheath (Terumo) did not pass through the artery despite a good pulsatile blood flow from the right radial artery. We then used a 0.014˝ Sion Blue coronary wire (Asahi Intecc), which was easily advanced in the right radial artery. However, although we performed a small skin cut around the coronary wire, the sheath dilator was stuck in the proximal radial artery wall. At this point, we performed a balloon angioplasty in the right radial artery with a 2.0 x 10 mm semicompliant balloon with 4 inflations up to 8 atm (Figure 1). After this maneuver, we successfully advanced the sheath into the right radial artery to perform coronary angiography without shifting to an alternative arterial approach. No hematoma, pseudoaneurysm, or compartment syndrome occurred. The following day, the patient was discharged.

The inability to advance the dedicated wire of the transradial sheath in a radial artery with a good pulsatile blood flow is a very rare event. In this case, the advancement of a high-performance 0.014˝ coronary wire is the only option to gain the vessel. Then, if the transradial sheath is stuck in the proximal radial artery wall, balloon angioplasty of the radial artery may allow successful reinsertion of the transradial sheath. This technique allows the preservation of radial artery access, avoiding a shift to an alternative arterial approach.

From the Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.

Disclosure statement: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided regarding use of the images herein.

Final version accepted March 11, 2020.

Address for correspondence: Giuseppe Talanas, MD, Clinical and Interventional Cardiology, Sassari University Hospital, Sassari (Italy), Via Enrico De Nicola, 07100 Sassari, Italy. Email: giuseppe.talanas@aousassari.it