Kassis Nicholas, Imran Hafiz, Soukas Peter A, Sklar Mitchel A
Brown University Health, Lifespan Cardiovascular Institute, Providence, Rhode Island, USA; Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Brown University Health, Lifespan Cardiovascular Institute, Providence, Rhode Island, USA; Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
JACC Case Rep. 2025 Jun 4;30(13):104178. doi: 10.1016/j.jaccas.2025.104178.
Catheter kinking/entrapment is a known complication of transradial coronary procedures. Although preventive measures are critical, operators must recognize the complication and the various methods to safely resolve it.
A 71-year-old man presented with progressive angina. A coronary angiogram via the right radial artery revealed a heavily calcified, subtotally occluded right coronary artery. Attempts to engage the right coronary artery resulted in an overtorqued, kinked guide catheter within the brachial artery. Initial resolution measures were unsuccessful. A novel alternative method-the simultaneous antegrade/retrograde double-balloon-handshake-inflation (SARDHI) technique-successfully resolved the kink. The SARDHI method involved obtaining alternative access, passing a guidewire distal to the kink, inflating 2 high-pressure coronary balloons on either side of the kink, and unraveling the kink in the larger-caliber axillary artery.
Catheter kinking management should be individualized to the patient's anatomy and risk factors. We present the first report of the SARDHI technique for safe kinked catheter extraction during coronary intervention.
TAKE-HOME MESSAGES: This case highlights the risk factors and early signs of a kinked transradial coronary guide catheter and frames the stepwise approach for its resolution. Techniques for preventing guide catheter kinking include resolving vessel spasm, avoiding catheter over-rotation, ensuring adequate guide support, and ensuring the guidewire remains in situ within the guide while torquing. The simultaneous antegrade/retrograde double-balloon-handshake-inflation (SARDHI) technique should be considered by proceduralists as a novel, viable method for percutaneous kinked catheter extraction given its technical ease, independence from a larger-bore catheter, and avoidance of distal catheter tip deformation.
导管扭结/卡压是经桡动脉冠状动脉介入手术中一种已知的并发症。尽管预防措施至关重要，但术者必须认识到该并发症以及安全解决它的各种方法。
一名71岁男性因进行性心绞痛就诊。经右桡动脉行冠状动脉造影显示右冠状动脉严重钙化、次全闭塞。尝试进入右冠状动脉导致肱动脉内导引导管过度扭转、扭结。最初的解决措施未成功。一种新颖的替代方法——顺行/逆行双球囊握手式充气（SARDHI）技术——成功解决了扭结问题。SARDHI方法包括获得替代入路，将导丝穿过扭结远端，在扭结两侧各充盈一个高压冠状动脉球囊，并在较大口径的腋动脉中解开扭结。
导管扭结的处理应根据患者的解剖结构和危险因素进行个体化。我们首次报告了SARDHI技术用于冠状动脉介入期间安全取出扭结导管。
本病例突出了经桡动脉冠状动脉导引导管扭结的危险因素和早期迹象，并制定了其解决的逐步方法。预防导引导管扭结的技术包括解除血管痉挛、避免导管过度旋转、确保足够的导引导管支撑以及确保在扭转时导丝仍留在导引导管内原位。鉴于其操作简便、不依赖大口径导管且避免远端导管尖端变形，手术医生应将顺行/逆行双球囊握手式充气（SARDHI）技术视为经皮取出扭结导管的一种新颖、可行的方法。
