Kinking of diagnostic catheter in radial artery during radial cardiac catheterization with superimposed arterial spasm

Fig. 1 – Schema of the loop of the diagnostic catheter and procedures for its removal. Case report: A 76-year-old female presented with a history of intermittent chest pain at rest during the previous two days. She had no significant past medical history and was on no medication. Chest X-ray was unremarkable, but her 12-lead electrocardiogram revealed lateral ST depressions of 2 mm. Coronary angiography was performed via her right radial artery. The radial artery puncture was straightforward, and a TIG 5F catheter was used to attempt left coronary angiography. Unfortunately, while struggling to pass through the severe tortuosity of the brachiocephalic artery, the catheter made a loop high in the radial artery close to the brachial bifurcation. Despite gentle attempts to rotate the catheter to undo the kinking, the catheter became stuck in the artery due to spasm, and even gentle manipulation was very painful for the patient. A cocktail of nitroglycerin and verapamil was repeatedly administered intra-arterially, and this relieved the spasm. We were unable to cross through the kinked portion, even with a coronary guide wire. An attempt was made to snare the tip of the catheter with the coronary loop via the right femoral artery and straighten the catheter. This was unsuccessful due to the severe tortuosity of the brachiocephalic artery. We considered vascular surgery to remove the catheter. Prior to going to the surgical department, however, we decided to make one last attempt to straighten the catheter. We cut off the end of the catheter, removed the 6F