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Digital Ischemia Following Radial Access Unmasking Systemic Sclerosis: Characteristic Intravascular Ultrasound
Shuhei Yamamoto1, Akihiro Nakajima1, Sunao Nakamura1
1Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki City, Kanagawa, Japan.
Insights
Radial artery access can trigger digital ischemia in patients with undiagnosed Systemic Sclerosis (SSc). This case shows how catheter procedures may reveal this autoimmune disease, leading to finger complications.
Area of Science:
- Cardiology
- Rheumatology
- Vascular Medicine
Background:
- Systemic sclerosis (SSc) involves microvascular dysfunction and fibrosis.
- Catheter procedures can exacerbate underlying vasculopathy in SSc patients.
Background:
Systemic sclerosis (SSc) is an autoimmune disease characterized by microvascular dysfunction and progressive fibrosis. Vascular injury related to catheter procedures may unmask latent vasculopathy in patients with SSc.
Case Summary:
An 81-year-old woman presented with chest pain and mild troponin elevation. Right radial access coronary angiography showed nonobstructive coronary artery disease. One month later, she developed black discoloration of the index and middle fingers. Angiography revealed severe radial artery stenosis at the prior access site, and balloon angioplasty restored flow. Intravascular ultrasound demonstrated homogeneous concentric intimal thickening consistent with fibrotic remodeling. Based on positive anticentromere antibody findings and characteristic skin changes, the patient was diagnosed with SSc.
Discussion:
This case highlights that radial artery access-induced digital ischemia may represent the initial clinical manifestation of previously unrecognized SSc.
Take-Home Message:
Clinicians should be aware that subtle peripheral signs of SSc may predispose patients to ischemic complications after radial artery access.
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