Related Experiment Video
Updated: Feb 12, 2026
Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
Reduction of catheter kinks and knots via radial approach
Itsik Ben-Dor1, Toby Rogers1, Lowell F Satler1
1Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Insights
Guide catheter kinking during radial access procedures can be resolved using various techniques. This review details methods from simple maneuvers to complex internal fixation for safe catheter removal.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Radial artery access for coronary angiography and percutaneous coronary intervention is increasingly common.
- Tortuous vascular anatomy can complicate guide catheter manipulation during radial procedures.
- Guide catheter kinking and knotting are potential complications requiring specific management strategies.
Observation:
- Simple maneuvers like traction and rotation may resolve minor kinks.
- Complex kinks and knots often necessitate advanced techniques.
- External compression, sheath exchange, and hydraulic pressure are external methods for knot resolution.
Findings:
- Internal fixation using a snare introduced via the femoral artery provides a method to untwist complex knots.
- Simultaneous rotation of both catheter ends facilitates untwisting.
- These techniques aim to enable safe removal of kinked or knotted catheters.
Implications:
- Effective management of catheter kinking and knotting improves procedural safety during radial interventions.
- Knowledge of these techniques can reduce complications and procedure times.
- This review offers practical solutions for interventional cardiologists facing challenging radial access cases.
Abstract:
Coronary angiography and percutaneous coronary intervention using the radial approach are becoming more frequent. Pronounced guide catheter manipulation in cases with tortuous access routes may lead to severe catheter kinking or knotting. The purpose of this review article is to present several techniques to resolve radial access catheter knots and kinks. First, simple maneuvers such as gentle traction, rotation, and guidewire advancement can often resolve minor kinking; however, complex loops and kinks are often not reversible with these simple maneuvers. Second, fixing the distal catheter tip using external compression, encasing the knot with a larger sheath, or untwisting the knot with hydraulic pressure can be useful. Finally, internal fixation by grasping the kinked catheter with a snare introduced via the femoral artery allows both ends of the catheter to be rotated in opposite directions to untwist the catheter for safe removal.
Related Concept Videos
01:23Radial System Protection
In a radial system with a fault downstream of the third breaker, ideally, only the third breaker will open, isolating the fault and interrupting the load connected beyond it. The second breaker has a longer delay setting,...
03:11Oxidation-Reduction Reactions
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation
02:36Oxymercuration-Reduction of Alkenes
01:22Block Diagram Reduction
The first step in this process is the identification and relocation of a branch point. A branch point, where a...