Abstract
Radial artery catheterization is a common procedure performed in the cardiac catheterization laboratory. Transradial accesssing is becoming an increasingly widespread choice because of its lower complications compared with the transfemoral approach. Although complications related to this procedure are well established, troubles associated with the guide wire are rare. We present the first reported case of a percutaneous rescue of a wire during radial sheath insertion using the balloon entrapment technique to retrieve it without surgery.
Improvements in percutaneous coronary interventions by transradial approach have reduced bleeding site complications. This makes it a preferred choice when compared to the traditional femoral route , but technical complications and their solutions pose a continuous challenge .
We present the case of a 45-year-old man who was admitted for an acute inferior myocardial infarction. He was initially treated by thrombolysis. Three days after admittance, he underwent a coronary angiography by the transradial route. A right radial puncture was performed with a steel needle and a steel sterilized radial-kit wire was inserted. While the radial sheath was placed correctly, the steel wire was inadvertently pushed and remained inside after dilator disengagement ( Fig. 1 , Panel A ). Fluoroscopy revealed the wire to be a few centimeters away from the artery port ( Fig. 1 , Panel A ). Our strategy was to allocate an angioplasty 0.014” wire (Balance Middle Weight, Abbott Inc®) through radial hemostatic valve next to the wire ( Fig. 1 . Panel B ). Then, we used a catheter balloon monorail 3.5/30 mm. We pushed it a few millimeters along the sheath and inflated it to 20 atm ( Fig. 1 , Panel C ), so that the displaced wire was trapped between the balloon and the angioplasty wire. The critical maneuver was to retrieve all devices simultaneously to fix the radial system wire outside ( Fig. 1 , Panel D ). After that, the radial sheath was reinserted and the procedure was completed successfully ( Fig. 1 , Panels E and F ).
