Related Experiment Video
Updated: Sep 9, 2025
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Severe Hand Ischemia Following Distal Transradial Coronary Intervention for Cardiac Arrest
Takeshi Yamada1, Shiori Kawakami1, Norimasa Taniguchi1
1Cardiovascular Department, Sakurakai Takahashi Hospital, Hyogo, Japan.
Insights
The distal transradial approach (dTRA) for coronary interventions can lead to severe hand ischemia, especially in critically ill patients. Careful monitoring is crucial to prevent complications like radial artery occlusion and potential amputation.
Area of Science:
- Cardiovascular Interventions
- Vascular Surgery
- Interventional Cardiology
Background:
- The distal transradial approach (dTRA) is gaining traction for coronary interventions.
- However, the associated risk of hand ischemia requires further investigation.
Observation:
- A patient undergoing percutaneous coronary intervention via dTRA developed complications including systemic inflammatory response syndrome and required extensive support.
- She subsequently developed severe ischemic changes in her right thumb, leading to amputation.
- Arteriography confirmed radial artery occlusion and an incomplete superficial palmar arch.
Findings:
- Radial artery occlusion following dTRA can result in significant hand ischemia.
- This risk is heightened in patients with complex post-procedural clinical courses.
Implications:
- Vigilant monitoring for ischemic complications is essential in patients undergoing dTRA, particularly those who are critically ill.
- This case highlights the potential for severe outcomes and the need for careful patient selection and post-procedure surveillance.
Background:
Despite growing interest in the distal transradial approach (dTRA) for coronary interventions, the risk of hand ischemia remains insufficiently elucidated.
Case Presentation:
A 72-year-old woman who experienced an out-of-hospital cardiac arrest was successfully resuscitated and diagnosed with acute myocardial infarction. Primary percutaneous coronary intervention was performed via dTRA with intra-aortic balloon pump support. Post-percutaneous coronary intervention, she developed systemic inflammatory response syndrome due to hypoperfusion during resuscitation, requiring high-dose norepinephrine, prolonged intra-aortic balloon pump support, and continuous renal replacement therapy. Ischemic changes gradually developed in her right thumb, which eventually became mummified and required amputation. Arteriography revealed radial artery occlusion and an incomplete superficial palmar arch.
Discussion:
radial artery occlusion following dTRA carries a potential risk of severe hand ischemia, particularly in patients with complex post-percutaneous coronary intervention clinical courses.
Take-Home Message:
This case underscores the importance of vigilant monitoring for ischemic complications associated with dTRA in critically ill patients.
More Related Videos
Related Concept Videos
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:30Acute Coronary Syndrome I: Introduction
01:27Peripheral Artery Disease III: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:27Angina II: Classification
01:27Assessment of the Cardiovascular System III: Palpation
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...