Percutaneous retrieval of a twisted guide catheter using a longer second radial sheath

Area of Science:

• Interventional Cardiology
• Vascular Access Techniques
• Medical Device Retrieval

Background:

• Radial artery access for coronary angiography and percutaneous coronary intervention (PCI) is increasingly recommended due to reduced bleeding and improved survival, particularly in ST-elevation myocardial infarction.
• Complex PCI and tortuous vascular anatomy can necessitate aggressive guide catheter manipulation, potentially leading to guide shaft damage, twisting, and entrapment within the radial artery.

Observation:

• Three cases are presented where coronary guide catheters became twisted and entrapped within the radial artery during PCI procedures.
• The entrapment occurred due to pronounced guide catheter manipulation, structural damage to the guide shaft, and twisting.

Findings:

• A minimally invasive retrieval technique was successfully employed in these three cases.
• The technique involves the use of a second introducer sheath of the same French (F) size but greater length than the initially placed sheath.
• This method allowed for the safe and effective removal of the twisted and stuck coronary catheter.

Implications:

• This technique offers a valuable solution for managing a rare but potentially serious complication during radial PCI.
• It provides interventional cardiologists with a practical, minimally invasive approach to device retrieval, potentially avoiding more complex surgical interventions.
• Successful implementation of this retrieval strategy can enhance procedural safety and patient outcomes in radial access interventions.