Recanalization of a Chronic Radial Artery Occlusion Allowing Subsequent Complex Coronary Intervention

Abstract

A 65-year-old man with previous coronary artery bypass grafting and recent recurrence of angina was referred for coronary angiography. His medical history included myelodysplasia with significant anemia (hemoglobin, 7.7 g/dL) and thrombocytopenia (platelets, 77×10 9 /L). A percutaneous coronary intervention was performed 4 years previous to an occluded native right coronary artery via the left radial artery. Given the increased risk of bleeding complications and a patent left internal mammary artery graft, coronary angiography was planned again via the left radial artery. The result of a modified Allen test was positive, demonstrating satisfactory ulnar arterial supply to the hand. Arterial puncture using a SURFLO micropuncture needle (Terumo Medical Corporation; Somerset, NJ) resulted in pulsatile blood flow back, but it proved impossible to advance the 0.021-inch introducer wire more than a few centimeters into the vessel. Therefore, the cannula on the introducer needle was advanced over the wire to secure arterial access and radial angiography was performed, which demonstrated radial artery occlusion (RAO; Figure 1; online-only Data Supplement Movie I). The occlusion was not believed to …