Successful Transradial Retrieval of Broken Catheter Fragment During Transradial Coronary Angiography

Abstract: Intravascular fracture of angiographic catheters is very uncommon, but it happens. Removal of an intravascular foreign body may require surgical intervention or non-surgical retrieval necessitating additional vascular access (mostly via femoral artery). We describe a case in which the diagnostic catheter was broken. We were able to pass two guidewires (0.035-inch guidewire and 0.014-inch standard percutaneous transluminal coronary angioplasty guidewire) through the fragment. The 0.014-inch guidewire twirled, winding around the 0.035-inch wire, and the catheter fragment was retrieved successfully through the radial sheath. 

J INVASIVE CARDIOL 2012;24:74-75

Key words: complication, catheterization, retrieval, transradial access

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Case Report

A 65-year-old male patient underwent coronary angiography via his right radial artery at our day care center because of positive result on treadmill test. During the left coronary angiogram, extravasation of contrast was noted near the bond between catheter tip and its body (Figure 1A, arrow). Fluoroscopy showed that the 4 French (Fr) catheter was partially broken (Figure 1B, arrow). A 0.035-inch J-tip wire was passed through the partially broken catheter and retrieval was attempted via a 4 Fr arterial sheath, but the catheter was completely broken (Figure 1C). After removal of the 4 Fr arterial sheath, a 6 Fr arterial sheath and a 6 Fr guiding catheter (Ikari Right, Terumo Corporation) was introduced over the 0.035-inch guidewire. A 0.014-inch standard percutaneous transluminal coronary angioplasty (PTCA) guidewire was introduced through the catheter fragment. The 0.014-inch guidewire twirled, winding around the 0.035-inch wire, and the catheter fragment was retrieved into a 6 Fr guiding catheter; the whole system was then successfully retrieved through the 6 Fr radial sheath (Figure 1D and Figure 2). A right coronary angiogram was performed using the other 4 Fr diagnostic catheter. The patient was discharged home on the same day uneventfully.

Discussion

Intravascular fracture of angiographic catheters is very uncommon,¹ but it happens. Retained guidewire or a catheter fragment may cause complications such as thrombosis, embolism, and sepsis. A previous study reported that catheter reusage is related to catheter fracture,¹ but we use every catheter only once in our lab, so catheter reusage was not an issue in this case. There was no vessel tortuosity and coronary cannulation was not difficult, so we did not perform any unusual manipulation in this case. Removal of an intravascular foreign body may require surgical intervention¹ or non-surgical retrieval. Snare-loop wire or its modification,² wire-balloon technique,³ and nitinol goose-neck snare⁴ can be used for non-surgical retrieval, but these techniques require vascular access (mostly femoral puncture).

In this case, the broken catheter fragment was successfully removed transradially using a two-guidewire technique without additional puncture of the femoral artery. Therefore, we were able to finish transradial coronary angiography as an outpatient procedure.⁵ We recommend that when partial fracture of the catheter is identified, a guidewire should be passed though the fragment before an attempt is made to withdraw the catheter. It is also noteworthy that a 0.014-inch guidewire winding around a 0.035-inch guidewire occupies 1.24-1.60 mm, whereas the inner diameter of the 4 Fr catheter is only 1.48 mm.

References

1. Kyriakides ZS, Bellenis IP, Caralis DG. Catheter separation during cardiac catheterization and coronary angiography. A report of four incidents and review of the literature. Angiology. 1986;37(10):762-765.
2. Watson LE. Snare loop technique for removal of broken steerable PTCA wire. Cathet Cardiovasc Diagn. 1987;13(1):44-49.
3. Kim JY, Yoon J, Jung HS, et al. Broken guidewire fragment in the radio-brachial artery during transradial sheath placement: percutaneous retrieval via femoral approach. Yonsei Med J. 2005;46(1):166-168.
4. Yedlicka JWJ, Carlson JE, Hunter DW, et al. Nitinol gooseneck snare for removal of foreign bodies: experimental study and clinical evaluation. Radiology. 1991;178(3):691-693.
5. Kim JY, Yoon J. Transradial approach as a default route in coronary artery interventions. Korean Circ J. 2011;41(1):1-8.

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From the Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea.
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 July 27, 2011, provisional acceptance given August 30, 2011, final version accepted September 20, 2011.
Address for correspondence: Keon-Woong Moon, MD, PhD, Department of Internal Medicine, St. Vincent’s Hospital, #93-6, Ji-dong, Paldal-ku, Suwon, Gyunggi-do, 442-723, South Korea. Email: cardiomoon@gmail.com