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"String Cheese" Partial Radial Artery Avulsion in a Patient Undergoing Cardiac Catheterization and Percutaneous
Richard Casazza1, David J Epstein1, Bilal Malik1
1Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA.
Background:
Radial artery avulsion (RAV) is a rare but potentially serious complication of transradial angiographic procedures.
Case Summary:
We describe a 70-year-old man who presented with atypical chest discomfort and who underwent cardiac catheterization from the right radial artery. The patient had radial artery spasm, and a piece of tissue approximately 6 cm in length was pulled out of the sheath. Pathological evaluation revealed a partial arterial intimal layer. The intima was avulsed off the arterial wall because of either the spasm or catheter-induced trauma. Conservative management was used to treat the patient.
Discussion:
Our case demonstrates the appearance of a partial RAV, otherwise coined "string cheese" avulsion, during transradial catheterization. Furthermore, we provide a system for classifying different types of RAVs.
Take-Home Messages:
RAV type can be determined by the appearance of the tissue avulsed. Determination of RAV type can potentially guide management strategies.
Related Concept Videos
Assessment 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:
Assessment 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
Cardiac Catheterization II: Right Heart Catheterization
Cardiac Catheterization I: Pre-Procedure Overview
Cardiac Catheterization III: Left Heart Catheterization
Cardiac Catheterization IV: Nursing Management

