Radial artery pseudoaneurysm rupture after cardiac catheterization

Area of Science:

• Cardiology
• Interventional Cardiology

Background:

• Atrial fibrillation (AF) is a common arrhythmia requiring anticoagulation.
• Percutaneous coronary intervention (PCI) is a standard treatment for coronary artery disease.
• Managing patients with both AF and coronary artery disease presents therapeutic challenges, particularly regarding antithrombotic therapy.

Observation:

• A 73-year-old male patient with a history of paroxysmal atrial fibrillation (AF) on apixaban therapy presented for PCI.
• The PCI procedure targeted the left anterior descending artery and was performed using a transradial approach.
• The patient had a complex medication regimen including apixaban and clopidogrel post-PCI.

Findings:

• Successful PCI of the left anterior descending artery was achieved via transradial access.
• The patient was discharged on a comprehensive medication list including apixaban, clopidogrel, atorvastatin, carvedilol, isosorbide mononitrate, and losartan.
• This regimen reflects a strategy to balance the risks of thrombotic events from both AF and recent PCI.

Implications:

• This case highlights the management of dual antiplatelet and anticoagulant therapy in patients with concurrent AF and coronary artery disease.
• Transradial access offers a minimally invasive option for PCI in this patient population.
• Optimizing antithrombotic strategies is crucial for preventing ischemic events while minimizing bleeding risk in complex cardiovascular patients.