Mikami Kazuyuki, Kuramoto Yoji, Kuroyama Takahiro, Ueno Yasushi
Neurosurgery, Shinko Hospital, Kobe, JPN.
Neurosurgery, Hyogo Medical University, Nishinomiya, JPN.
Cureus. 2025 Jun 17;17(6):e86238. doi: 10.7759/cureus.86238. eCollection 2025 Jun.
Cerebral angiography remains the gold standard investigation for cerebrovascular disease. Transradial access is increasingly preferred over the transfemoral approach because it facilitates early ambulation and reduces complications at the access site. We report a woman in her 70s who developed delayed peripheral circulatory failure in the digital arteries following transradial cerebral angiography. After inserting a 4-French sheath into the conventional right radial artery, the catheter was advanced toward the subclavian artery but inadvertently entered a small accessory brachial artery with significant resistance, provoking severe vasospasm. The procedure was completed without incident after redirecting the catheter into the main brachial artery. Symptoms gradually appeared 24 hours after the procedure, and after 48 hours, the patient experienced burning pain, weakness, and pallor in her right hand. Angiography via the brachial artery demonstrated diffuse spasm of the radial artery, palmar arch, and digital arteries. Intra-arterial nitroglycerin quickly restored flow and alleviated symptoms. This case illustrates that inadvertent cannulation of an accessory brachial artery during transradial access can lead to delayed digital circulatory failure and that early intra-arterial vasodilator therapy is effective. Careful observation is necessary if such a catheter deviates into a small vessel with an anatomical anomaly, and spasm occurs.
脑血管造影术仍然是诊断脑血管疾病的金标准检查方法。经桡动脉途径相较于经股动脉途径越来越受到青睐，因为它便于患者早期活动，并减少穿刺部位的并发症。我们报告了一位70多岁的女性，她在经桡动脉脑血管造影术后出现了指动脉延迟性外周循环衰竭。在将一根4法国规格的导管鞘插入右侧常规桡动脉后，导管向锁骨下动脉推进，但意外进入了一条细小的副肱动脉，遇到明显阻力，引发了严重的血管痉挛。在将导管重新导入肱动脉主干后，手术顺利完成。术后24小时症状逐渐出现，48小时后，患者右手出现灼痛、无力和苍白。经肱动脉造影显示桡动脉、掌弓和指动脉弥漫性痉挛。动脉内注射硝酸甘油迅速恢复了血流并缓解了症状。该病例表明，经桡动脉穿刺时意外插入副肱动脉可导致延迟性指循环衰竭，早期动脉内血管扩张剂治疗是有效的。如果导管误入存在解剖异常的小血管并发生痉挛，必须进行仔细观察。
