Successful removal of an entrapped and kinked catheter during right transradial cardiac catheterization by snaring and unwinding the catheter via femoral access

Prevention and treatment of coronary catheter kinking

Coronary catheter kinking is an uncommon but potentially catastrophic complication of cardiac catheterization. Although simple maneuvers can often result in resolution of a kink, tighter knots may not respond to such measures. We provide a systematic, stepwise approach to the prevention and treatment of catheter kinking.

Novel Method for Restitution of a Torqued and Entrapped Kinked 7F Catheter in the Ascending Aorta

Knotting and kinking of diagnostic coronary artery catheters are potentially catastrophic complications though their occurrence is uncommon. However, abrupt kinking of 7F guide catheters in the ascending aorta becomes a quirky puzzle. This case emphasizes the importance of avoiding kinking and provides recommendations for catheter retrieval in the unlikely event of this complication. To the best of our knowledge, the technique used in our case has not been described before.

The Prevalence of Cardiovascular Complications and Causes of AngioJet Failure: A Post-Marketing Surveillance Study Based on the MAUDE (Manufacturer and User Facility Device Experience) Database

Background and objective Aspiration thrombectomy devices, such as the AngioJet Solent Omni (Boston Scientific Corporation, Marlborough, MA) have been approved by the US FDA for the treatment of thrombi in peripheral arterial disease, venous disease, and AV fistulas. However, there is a dearth of real-world data on the most common modes of failure and complications associated with the AngioJet Solent Omni. In this study, we aimed to address this scarcity of data. Methods The MAUDE (Manufacturer and User Facility Device Experience) database was queried for reports of device failure and adverse events spanning the period from October 2012 to December 2021. Results A total of 499 events were reported during the study period. After the exclusion of duplicate reports, the final analysis included 450 reports. The most common mode of failure was catheter breakage/kinking during suction thrombectomy with 137 reports (30%). The most common vessel associated with events was the superficial femoral artery or vein, which was documented in 82 reports (18.2%). The most common adverse clinical outcome was the embedding of a piece of the device in the patient, which occurred in seven reports (1.6%). There were seven (1.6%) events of death reported during the period studied. Conclusions Based on our findings, theAngioJet Solent Omni device provides promising results; however, it is important to evaluate device safety. It is associated with complications including device embedment, catheter breakage/kinking, and death, and these adverse events are linked to patient characteristics and risk factors.

Algorithms for challenging scenarios encountered in transradial intervention

Transradial intervention (TRI) was first introduced by Lucien Campeau in 1989 and since then has created a lasting impact in the field of interventional cardiology. Several studies have demonstrated that TRI is associated with fewer vascular site complications, offer earlier ambulation and greater post-procedural comfort. Patients presenting with ST Segment Elevation Myocardial Infarction (STEMI) have experienced survival benefit and higher quality-of-life metrics as well with TRI. While both the updated scientific statement by the American Heart Association and the 2017 European Society of Cardiology guidelines recommend a “radial first” approach there appears to be a lag in physicians adapting TRI as the preferred vascular access. We present a review focusing on identification and management of TRA related challenges and complications using a systematic algorithmic approach.

What Knot to Do: Retrieval of a Kinked and Trapped Coronary Catheter

Diagnostic coronary artery catheter knotting and kinking are uncommon but potentially catastrophic complications. Our case emphasizes the importance of avoiding this problem and provides recommendations for catheter retrieval in the unlikely event of this complication. To our knowledge, the technique used in our case has not been described before. (Level of Difficulty: Intermediate.).

Reduction of catheter kinks and knots via radial approach

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.

An avulsed radial artery with a high take-off

A 63-year-old female was diagnosed with severe aortic stenosis, who underwent a diagnostic coronary angiography via transradial approach prior an aortic-valve replacement. After imaging the left coronary system, entrapment of the diagnostic catheter was encountered as a result of spasm of the radial artery. An arteriogram of the arm revealed an anatomical variation in the radial artery (high take-off). Several attempts to remove the entrapped catheter resulted in avulsion of the artery, which was managed successfully with coil embolization. To our knowledge, no such complication has been reported.

Symptomatic radial artery thrombosis successfully treated with endovascular approach via femoral access route

Radial access has been increasingly utilized for coronary intervention due to higher safety profile in comparison to femoral access site with lower bleeding rate. Radial artery occlusion is not uncommon with radial access site. This usually does not lead to any harm due to ulnar artery collaterals that are sufficient to prevent hand ischemia and is usually left alone. However, in the case of significant hand ischemia, treatment is often necessary. We are reporting an interesting case of symptomatic radial artery thrombosis leading to arm ischemia that was successfully treated percutaneously using femoral access. Using femoral access for radial artery intervention has not been reported previously. This case is followed by review of the literature.

Simple nonsurgical method of reduction of coronary catheter knot

Knotting and kinking of the coronary catheter is one of the complications during diagnostic or interventional procedures. These complications can be tackled percutaneously without subjecting the patient to surgery. We are reporting one such case of catheter knotting and how it was reduced percutaneously.

Catheter-induced Brachial Artery Dissection during Transradial Angioplasty

The transradial approach is becoming a very popular technique in coronary and peripheral interventions because of its low vascular complication rate and improved patient comfort. Reported complications during the transradial approach are radial artery spasm, perforation, occlusion and formation of pseudoaneurysms. The kinking of the diagnostic catheter during catheter manipulation in a severely tortuous subclavian artery can occur very easily, and catheter movements at this point can cause barchial and subclavian artery dissection. We report a case of brachial and subclavian artery dissection during transradial diagnostic angiography, treated by angioplasty and stenting.