Simultaneous Antegrade/Retrograde Double-Balloon-Handshake-Inflation (SARDHI) Technique: A Novel Method to Reduce Kinked Transradial Coronary Guide Catheter.

BACKGROUND

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.

CASE SUMMARY

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.

DISCUSSION

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.