Percutaneous technique for the reduction of knotted coronary catheters

Balloon internal fixation: A novel approach to manipulate catheter knotting

A successful alternative technique to resolve the catheter knotting during radial access using balloon internal fixation of 5F angiographic catheter in the cath laboratory.

Transfemoral Technique to Untwist a Knotted Catheter in the Brachial Artery: A Case Report

Cardiac catheterization using the transradial access has been proven to be safe, but can be complicated in some cases by catheter kinking or knotting. This complication is often the result of excessive manipulations due to the S-shaped configuration of the right subclavian-innominate-aorta axis. When a knot occurs in the brachial artery, regular maneuvers to unknot the catheter can be unsuccessful due to the narrow diameter of the artery or to the failure of the external fixation of the distal part of the catheter. We present a case of a knotted catheter in the brachial artery, untwisted with a snare technique. This endovascular technique is simple and avoids surgical extraction.

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.).

Catheter steering in interventional cardiology: Mechanical analysis and novel solution

In recent years, steerable catheters have been developed to combat the effects of the dynamic cardiac environment. Mechanically actuated steerable catheters appear the most in the clinical setting; however, they are bound to a number of mechanical limitations. The aim of this research is to gain insight in these limitations and use this information to develop a new prototype of a catheter with increased steerability. The main limitations in mechanically steerable catheters are identified and analysed, after which requirements and solutions are defined to design a multi-steerable catheter. Finally, a prototype is built and a proof-of-concept test is carried out to analyse the steering functions. The mechanical analysis results in the identification of five limitations: (1) low torsion, (2) shaft shortening, (3) high unpredictable friction, (4) coupled tip-shaft movements, and (5) complex cardiac environment. Solutions are found to each of the limitations and result in the design of a novel multi-steerable catheter with four degrees of freedom. A prototype is developed which allows the dual-segmented tip to be steered over multiple planes and in multiple directions, allowing a range of complex motions including S-shaped curves and circular movements. A detailed analysis of limitations underlying mechanically steerable catheters has led to a new design for a multi-steerable catheter for complex cardiac interventions. The four integrated degrees of freedom provide a high variability of tip directions, and repetition of the bending angle is relatively simple and reliable. The ability to steer inside the heart with a variety of complex shaped curves may potentially change conventional approaches in interventional cardiology towards more patient-specific and lower complexity procedures. Future directions are headed towards further design optimizations and the experimental validation of the prototype.

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.

Yet more knots in the radial artery, unravelling purely by counter clockwise rotation

We describe here two more radial knots that could be unravelled by counter-clockwise rotation alone. We and others have previously described radial knots that occur when trying to engage the right coronary artery (RCA). Here, we show two knots that were unravelled purely by counter-clockwise rotation. One occurred during RCA catheterisation and the other occurred during left coronary angiography via the radial route. In one of the patients, severe pain occurred in the right shoulder. This occurred even though the artery was not in spasm. We were able to move the catheter. Therefore it is possible that pain combined with the ability to move the catheter may be a marker of an intravascular knot.

Fracture of a guiding catheter in a tortuous iliac artery and its retrieval by a larger sheath

Intravascular fracture of catheters, especially guiding catheters, is uncommon. We present an unusual case in which a guide twisted and broke in a tortuous iliac artery during manipulation of the guiding catheter with a 0.014 inch wire firmly trapped inside and was retrieved by a larger sheath.

Knots in the cath lab, an embarrassing complication of radial angiography

Most case reports or series describe knots in the venous system such as knots of Swan-Ganz catheters, pacing wires or thermodilution catheters. Knots during radial angiography are relatively rare. Here we describe a simple method of unravelling a radial knot via the femoral route, together with a review of the literature on knots in the catherisation laboratory and the techniques to deal with them.

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

Since its introduction by Campeau in 1989, the transradial approach for coronary angiography has gained significant popularity among interventional cardiologists due to its lower access site complication rates, cost-effectiveness, and shorter hospital course. Although the transradial approach is much safer than the transfemoral approach, it has its own inherent rare complications including radial artery occlusion, thrombosis, nonocclusive radial artery injury, vasospasm, and compartment syndrome. Herein, we present an unusual case of entrapment and kinking of a catheter in the radial artery, which was successfully removed by using a gooseneck snare via the transfemoral route. The distal and proximal tips were then simultaneously rotated in opposite directions, allowing for the unkinking and removal of the catheter. To our knowledge, this is the first report of this rare complication.