Abstract
Radial artery spasm is a rare complication of transradial cardiac catheterization. We describe a case of severe radial artery spasm causing catheter entrapment. The spasm was resistant to local and systemic vasodilator administration, moderate sedation, and application of warm blankets over the affected arm. While preparations were being made for inducing general anesthesia, ViperSlide™ (Cardiovascular Systems, Inc. St. Paul, Minnesota) was delivered through the radial sheath resolving the spasm. Coronary angiography could not be performed using standard catheters, but was successfully completed using a 6 French Ikari left guide catheter (Terumo, Somerset, New Jersey).
Highlights
- •
Radial spasm is a frequent complication during transradial cardiac catheterization.
- •
Radial spasm is commonly treated with supportive measures that include local and systemic vasodilator administration, moderate sedation, and application of warmth to the affected arm.
- •
Administration of lubricant solutions, such as Viperslide, may result in spasm relief and allow for performance of coronary angiography with use of specialized catheters.
1
Introduction
Cardiac catheterization using transradial access (TRA) markedly reduces the risk for vascular access complications and improves patient comfort and has been increasingly used in the United States . However, TRA can be associated with specific challenges and complications, such as radial artery spasm. We describe a case of severe radial artery spasm that was refractory to local and systemic vasodilator administration, sedation, and warming of the arm, but resolved after administration of ViperSlide™ (Cardiovascular Systems, Inc. St. Paul, Minnesota).
2
Case report
A 53-year-old old man with aortic and mitral mechanical valves was referred for coronary angiography due to dysrhythmias causing syncope. To avoid interruption of warfarin, coronary angiography was performed using radial access. INR at the time of cardiac catheterization was 2.78. Right radial access was obtained. After administration of 200 mcg of nitroglycerin through the radial sheath the right coronary artery was engaged using a Jacky 6 French catheter (Terumo Medical Corporation, Somerset, New Jersey), and angiography was successfully performed ( Fig. 1 A ). However during movement of the image intensifier the radiation shield hit the right forearm, causing severe radial artery spasm. Subsequent attempts to manipulate or withdraw the Jacky catheter failed, and the patient experienced intense forearm discomfort. However, no significant bruising or hematoma was evident.
Nitroglycerin and verapamil were administered through the radial sheath without improvement. Warm blankets were placed over the forearm. Nitroglycerin was also injected subcutaneously around the radial artery. Intravenous nitroglycerin drip was started and increased up to a dose of 20 mcg/min. The patient was given several doses of midazolam and fentanyl for sedation, however the radial artery spasm persisted not allowing any catheter movement. Anesthesia was contacted, and preparations were made for inducing general anesthesia to relieve the radial artery spasm. Radial angiography demonstrated persistent radial artery spasm ( Fig. 1 B).
As a last resort effort, 10 mL of ViperSlide™ (Cardiovascular Systems, Inc. St. Paul, MN) was administered via the radial artery sheath resulting in successful removal of the catheter within one minute. Attempts to advance several diagnostic catheters (4 and 6 French JL4, 5 French AL1) failed due to severe forearm discomfort and resistance to advancement. However, a 6 French Ikari left (IL) 3.5 guide catheter (Terumo) was successfully advanced to the ascending aorta enabling left main engagement and angiography. No significant coronary disease was present ( Fig. 1 C), and the patient was dismissed without complications. Total fluoroscopy time was 10.2 minutes, air kerma dose was 0.516 Gray, and 105 mL of contrast were used.
2
Case report
A 53-year-old old man with aortic and mitral mechanical valves was referred for coronary angiography due to dysrhythmias causing syncope. To avoid interruption of warfarin, coronary angiography was performed using radial access. INR at the time of cardiac catheterization was 2.78. Right radial access was obtained. After administration of 200 mcg of nitroglycerin through the radial sheath the right coronary artery was engaged using a Jacky 6 French catheter (Terumo Medical Corporation, Somerset, New Jersey), and angiography was successfully performed ( Fig. 1 A ). However during movement of the image intensifier the radiation shield hit the right forearm, causing severe radial artery spasm. Subsequent attempts to manipulate or withdraw the Jacky catheter failed, and the patient experienced intense forearm discomfort. However, no significant bruising or hematoma was evident.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
