Author + information
- Received April 21, 2015
- Accepted April 25, 2015
- Published online September 1, 2015.
- Catherine Jaworski, MD∗,
- Adam J. Brown, MD∗,
- Stephen P. Hoole, MD∗,
- Martin Goddard, MD† and
- Nick E.J. West, MD∗∗ ()
- ∗Department of Interventional Cardiology, Papworth Hospital, Cambridge, United Kingdom
- †Department of Pathology, Papworth Hospital, Cambridge, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Nick West, Interventional Cardiology, Papworth Hospital, Cambridge, Cambridgeshire CB23 3RE, United Kingdom.
A 77-year-old woman with effort angina returned for intervention to her proximal circumflex and second obtuse marginal (OM2) artery. Angiography was undertaken transradially. Mild radial intra-arterial spasm was treated with intra-arterial glyceryl trinitrate, and a hydrophilic-coated guidewire was passed to the aortic root. The circumflex artery was selectively engaged secondary to a short left main stem, with maintenance of a normal arterial pressure trace. The first acquisition demonstrated a new hazy filling defect (arrow) in the first obtuse marginal branch (OM1) (Figure 1A, Online Video 1). The patient remained stable and pain free. Subsequent acquisitions demonstrated an occluded (arrow) OM1 (Figure 1B, Online Video 2). Because the patient was stable, the uninvolved OM2 stenosis was treated with a drug-eluting stent. With some difficulty, a Sion wire (Asahi Intecc, Nagoya, Japan) was successfully passed beyond the OM1 occlusion. Several passes of manual thrombectomy were performed without yield and with an unchanged angiographic appearance. A third pass did not deliver any debris into the syringe; however, on exiting the guide catheter, a long, 25-mm object was expelled (Figure 1C). The angiographic appearance completely resolved (Thrombolysis In Myocardial Infarction flow grade III), and the procedure was completed with stent deployment in the proximal circumflex (Figure 1D, Online Video 3). Histopathology confirmed radial artery embolus (Figures 1E and 1F). The patient’s forearm remained unchanged. Radial artery embolization is a very rare complication of transradial intervention, not previously documented in the literature, fortuitously with a good ending on this occasion. Aggressive treatment of arterial spasm is prudent before guide insertion to prevent intra-arterial stripping.
For supplemental videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 21, 2015.
- Accepted April 25, 2015.
- American College of Cardiology Foundation