Coronary Embolism After Iatrogenic Radial Endarterectomy

Abstract: A 55-year-old man with double-vessel coronary artery disease was revascularized by percutaneous coronary intervention three years ago. Elective coronary angiography was indicated for angina with positive stress test. During the procedure, severe radial spasm occurred; after the first injection, we detected loss in pressure trace in the diagnostic catheter and acute distal circumflex occlusion. Suspecting catheter thrombosis with coronary embolization, the entire system was exchanged and inspected; inside, we discovered a 2 x 50 mm white biological cylinder. Histological study of this material was compatible with endarterectomy. We present a rare complication of severe radial artery spasm and endarterectomy, with occlusion of the diagnostic catheter and coronary embolization.

J INVASIVE CARDIOL 2016;28(6):E54-E55

Key words: radial spasm, transradial complications, coronary embolization

A 55-year-old man with double-vessel coronary artery disease in the ostial circumflex and mid left anterior descending coronary arteries was revascularized with double-stenting 3 years ago.

Elective coronary angiography was indicated for angina with positive stress test. Severe radial spasm occurred during the procedure. After the first injection, we detected loss in pressure trace in the JL4 Super Torque Plus diagnostic catheter (Cordis Corporation) accompanied by chest pain and inferior ST-segment elevation. Left dominance, critical ostial left anterior descending (LAD) stenosis, and acute circumflex distal occlusion were observed (Figure 1A). We suspected catheter thrombosis with coronary embolization; therefore, the entire system was exchanged and we aspirated biological material from the circumflex with a Hunter extraction catheter (Iberhospitex Cordynamic SA), which effectively produced a patent artery, ST-segment normalization, and disappearance of chest pain. A stent was then implanted in the ostial LAD, with good angiographic result (Figure 1B).

Once the procedure was completed, the initial diagnostic catheter was inspected and evinced a 2 x 50 mm, white, cylindrical object (Figures 1C and 1D). Histological study confirmed the presence of arterial endothelium and intimal tissue compatible with endarterectomy (Figures 1E and 1F).

We show a rare complication of severe radial artery spasm and partial endarterectomy, with occlusion of the diagnostic catheter and coronary embolization. Radial spasm is a common complication of transradial coronary angiography and can produce catheter entrapment; the handling of this complication may damage the integrity of the vessel.

From the Cardiology Department, Hospital Universitario Central de Asturias, Asturias, Spain.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Moris reports proctoring fees from Medtronic and advisory board fees from Medtronic. The remaining authors report no conflicts of interest regarding the content herein.

Manuscript submitted March 21, 2016 and accepted March 23, 2016.

Address for correspondence: Jose Rozado, MD, Cardiology Department, Hospital Universitario Central de Asturias, Avd. Roma sn, 33011 Oviedo, Asturias, Spain. Email: joserozadocast@gmail.com