Balloon-assisted tracking: A practical solution to avoid radial access failure due to difficult anatomical challenges

The balloon assisted tracking (BAT) technique is utilised to overcome various anatomical difficulties during radial procedures when standard measures such as adequate sedation, pain relief, vasodilators and use of hydrophilic guidewires, fail. The aim of this study was to evaluate the success rates of the BAT technique in overcoming anatomical difficulties during radial coronary interventional procedures.

We retrospectively reviewed 1100 consecutive patients undergoing coronary procedures from the transradial approach (TRA) between May 2015 and May 2017. Anatomic variations and equipment used were recorded from procedure logs.

Overall 30 patients (2.72%) required the use of BAT. Mean age was 66.7years, with a range from 48 to 90years (53.3% female). Out of these 30 cases, 86.7% patients underwent percutaneous coronary intervention (PCI) while the remaining patients underwent coronary angiography alone. Acute coronary syndrome cases represented 63.3% of the cases while the remaining patients were elective procedures. Anatomical difficulties included severe, non-resolving radial spasm (66.6%), catheter induced radial or brachial perforation (16.6%), small calibre and/or diseased radial artery (10.0%), severe radial, branchial and/or subclavian tortuosity (3.0%) and radial loops (3.0%). Anatomical difficulties were overcome in all cases (100%). Coronary angiography and/or PCI were successfully completed in all 30 cases without the need for obtaining alternative arterial access. Mean added procedural time was 131s. There were no procedure related complications.

Balloon assisted tracking is a highly successful and safe technique for overcoming various anatomical difficulties at the level of the radial, brachial or subclavian arteries, which minimises the need for alternative arterial access.