Radial Artery Perforation Mx with Internal Tamponade using a

A 60-year-old man with past medical history of coronary artery disease, hypertension and diabetes was evaluated for worsening exertional angina. He underwent exercise nuclear stress test during which, with moderate exercise, he developed chest pain and ST segment changes. Thallium based single-photon emission computed tomography imaging showed moderate anterolateral ischemia. He was then referred for cardiac catheterization at our lab. A Barbeau test of the right radial artery prior to catheterization showed a type A pattern [1-6]. Right radial artery access was obtained with 21-gauze needle and a 0.025” wire was then advanced into radial artery without any resistance. 200 mcg of intra-arterial Nitroglycerine was administered via a 21-gauze cannula in the radial artery and the 0.025” wire was reintroduced. A French GlideSHEATH 250 mm was then advanced over the wire. Due to difficulty crossing with a 0.035 J wire through the upper arm, an angled GlideWIRE 0.035×180 cm was advanced easily to the aortic root. A French JR4 (Cordis, diagnostic catheter) and Radial Tiger 4.0 5F (Terumo, diagnostic catheter) catheters were respectively used to intubate the right and left coronary artery. Angiography revealed multi-vessel coronary artery disease with sequential ostial and proximal left anterior descending (LAD) 50% stenosis, 90% first obtuse marginal branch (OM) stenosis, a 70% posterior descending artery (PDA) stenosis and a totally occluded posterolateral artery. It was unclear whether the perfusion defect pertained to the LAD or OM ....