Despite lower rates of bleeding and vascular complications as compared to transfemoral approach, the adoption of TRA has been relatively slow in part due to frustration from operator failure during the learning curve. Anatomical challenges of subclavian, innominate, and aortic arch regions play an important role in TRA procedural failure. Using a simple, conceptual, framework to classify the anatomical or functional problem and then applying a logical approach to these challenges can facilitate management and augment operator success rates for TRA.
Hand contrast injection TIG OPTITORQUE catheter a b s t r a c t A 70-year-old hypertensive female presented with exertional angina (NYHA class II).Clinical cardiac examination and electrocardiogram was normal. Echocardiography was normal except grade I diastolic dysfunction. Coronary angiogram revealed non-obstructive coronary artery disease. Left ventricular angiogram was performed by hand injection using 5F TIG OPTITORQUE catheter (Terumo Corporation, NJ.), which was complicated by myocardial staining, myocardial perforation and pericardial effusion. Patient was managed conservatively and discharged on fourth day with stable hemodynamic condition. Echocardiogram performed on tenth day of event revealed resolution of pericardial effusion.
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