Severe catheter kinking and entrapment during transradial coronary angiography: Percutaneous retrieval using a sheathless guide catheter

Abstract

The transradial (TR) approach for coronary angiography and intervention is increasingly used worldwide because of several advantages such as reduced bleeding and vascular complications. During TR procedures, aggressive catheter manipulation in the setting of complex and tortuous arterial anatomy can lead to catheter kinking and entrapment. Several percutaneous retrieval techniques using either homolateral radial access or femoral access have been described previously. We demonstrate, for the first time, the use of a sheathless guide catheter as a rescue technique to successfully retrieve a severely kinked and entrapped diagnostic catheter during TR access. © 2014 Wiley Periodicals, Inc.

Balloon internal fixation- a novel approach to manipulate catheter knot

“…In our case, the internal diameter of 6 French EBU guiding catheter was 1.8mm, which was bigger than the external diameter of 5 French angiography catheter, which was 1.7mm, and make sure that the guiding catheter can enclose the angiography catheter. According to Aminian's study [11] , the length of guiding catheter was between "Knotted point-Puncture point" distance and "Knotted point-Cut point" distance, and the length of exceeded-guiding catheter part of angiography catheter was too short to fix, so that we make balloon and angiography catheter contact tightly and as a result we prolong the length of exceeded-guiding catheter part of angiography catheter sufficiently in order to facilitate the procedure, which was a bright point of our case.…”

Algorithms for challenging scenarios encountered in transradial intervention

“…Replacing the sheath with a larger and longer sheath and advancing it to the kinked segment of the catheter allows gently retracting the catheter into the larger sheath and its withdrawal. 24 Internal Fixation with femoral access and advancement of a 6Fr catheter into the innominate and snaring the proximal end of the kinked catheter fixates the catheter for untwisting at the wrist with gentle advancement of a 0.035″ hydrophilic wire through the catheter. 25 The detailed algorithm for managing a catheter kink is outlined in Fig.…”

“…Replacing the sheath with a larger and longer sheath and advancing it to the kinked segment of the catheter allows gently retracting the catheter into the larger sheath and its withdrawal. 24 …”

Reduction of catheter kinks and knots via radial approach

“…Pushing these large sheaths without their respective introducers directly over the trapped catheter could potentially risk trauma to the radial artery and stripping of the arterial intima. This technique has been described using long sheaths or sheathless guide catheters .…”