Letter to the Editor

Balloon-assisted tracking of guide catheter dealing with radial artery perforation and subclavian loop during percutaneous coronary intervention by transradial approach☆

The characterization of radial artery perforation (RAP) patterns using optical coherence tomography (OCT) has not been well established. This study aimed to identify the characteristic RAP patterns in patients diagnosed through post-procedural OCT examination.

This retrospective study included 1936 consecutive patients who underwent radial artery (RA) OCT following OCT-guided transradial coronary intervention (TRI) from January 2016 to July 2022. Data regarding RAP characteristics were collected through OCT, including the perforation site as well as dimensions such as the length, width, and arc. Furthermore, RAP types were classified as small or large perforations, with a cut-off arc value of ≤90°.

RAP, as identified by RA angiography (RAA) during TRI and on post-procedural OCT, was found in 16 out of 1936 patients (0.83 %). RA OCT imaging showed that the median distance between the RA ostium and the perforation site, the perforation length, width, and arc were 30.6 (14.4–42.2) mm, 1.55 (1.03–1.92) mm, 0.74 (0.60–1.14) mm, and 42.5 (25.0–58.1) °, respectively. Small perforations (arc ≤90°) were observed in 14 out of the 16 (87.5 %) patients with RAP. Post-procedural RAA revealed that 15 out of the 16 (93.7 %) patients with RAP had sealed perforations, with the remaining patient requiring external compression.

Our findings demonstrated that RAP is uncommon during TRI, with clearly defined characteristic patterns on OCT. Most RAPs are small and tend to spontaneous seal through catheter tamponade.

A 78 year old woman was admitted with an acute coronary syndrome. She underwent coronary angiography via the left radial artery which was complicated by a guide catheter induced radial artery perforation confirmed by extravasation of contrast into the forearm. We used balloon assisted tracking and guide catheter tamponade to complete the angioplasty procedure via the radial artery and successfully seal the radial artery perforation. We describe a series of 7 cases where this technique was used to both treat radial artery perforation and to complete the angioplasty via the radial approach.

In a patient with a small-calibre radial artery and a 360° radio-ulnar loop, we combined the balloon-assisted tracking (BAT) technique (used to track a catheter trough the loop) with the use of a 6.5 F PB sheathless guiding catheter, in order to allow the extensive catheter manipulations needed for PCI despite the ongoing artery spasm.