Radial Artery Embolism: A Rare Complication of Angioplasty

Abstract: We present a 55-year-old man with multivessel coronary artery disease previously treated with stenting of the left main, left anterior descending, right coronary, circumflex, and first diagonal branch. He was diagnosed with in-stent restenosis of a diagonal branch, but treatment was complicated by radial artery coronary embolism, which is a rare complication of radial intervention.

J INVASIVE CARDIOL 2016;28(8):E73-E74

Key words: complications, radial artery intervention, thrombectomy

Case Presentation

A 55-year-old man with multivessel coronary artery disease was previously treated with stenting in the left main coronary artery (LMCA), left anterior descending (LAD) artery, right coronary artery, circumflex (CX) artery, and first diagonal branch. He was admitted for effort angina. Angiography with 5 Fr catheters was performed (Figure 1A). Angioplasty was indicated for in-stent restenosis of a diagonal branch. A 6 Fr guiding catheter was advanced, with slight resistance in the radial artery. Angiography showed a radiolucent image occluding the LMCA-LAD (Figure 1B). A catheter aspiration was unsuccessful. Balloon dilation restored the LAD flow, but the hazy image migrated into the LMCA-CX, occluding the CX (Figure 1C). A further balloon dilation toward the CX achieved flow recovery, but the radiolucent image remained (Figure 1D). Aspiration was again unsuccessful. Intracoronary and intravenous abciximab was infused. The hazy image remained visible on angiography 3 days later. Chest pain, severe hypotension, and ST-segment changes appeared. A repeat aspiration was attempted. Once outside the guide catheter, a 3 cm-long, thin, white fragment of tissue was found adhered to the catheter aspiration tip (Figure 1F). In a subsequent angiogram, the image had disappeared (Figure 1E). The pathological study revealed intimal and medial layers of the arterial wall (radial). 

Radial artery coronary embolism is a rare complication of radial intervention. Persistence of the image after abciximab in the second procedure suggested a radial artery embolism that was removed during catheter aspiration. Treatment of arterial spasm is recommended before guide insertion to avoid radial stripping.

From the Hospital de Sant Pau, Hemodynamic Unit, Barcelona, Spain.

Disclosure: 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.

Manuscript submitted April 15, 2016 and accepted April 22, 2016.

Address for correspondence: Dr Vicens Marti, Hospital de Sant Pau, Hemodynamic Unit, Calle Sant Quintí 89, 08026 Barcelona, Spain. Email: vmarti@santpau.cat