CASE PRESENTATION
A 62-year-old woman with history of hypertension underwent selective
coronary angiography because of intermittent chest pain for 10 days. The
right radial artery was the access of choice. After easy cannulation, 5
French multifunctional angiography catheter (Terumo Corporation) was
introduced into aortic sinus. Initially, subclavian tortuous anatomy
made catheter rotation redundancy, and then the pressure curve was
partial dampening, and with fluoroscopy it revealed an outright knot
within right brachial artery (Fig 1). Gentle traction or rotation did
not allow catheter withdrawal. We decided to untwist the catheter knot
by balloon internal fixation and the details were as follows: Cut off
the tail of discounted catheter and the tip of 6 French EBU3.5 guiding
catheter (Medtronic). A 2.0×20mm balloon(Sprinter legend,Medtronic)
passed through the cut guiding catheter from tail to tip(Fig 2) and then
passed through the cut angiography catheter(Fig 3). When the balloon all
passed through the cut angiography catheter, the balloon was given
atmospheric pressure of about 14 atm and make sure that the balloon and
the angiography catheter contact tightly (Fig 4). The guiding catheter
was pushed to the knot point along angiography catheter by left hand.
The balloon was pulled out gently under fluoroscopy and the knotted
catheter was pulled out successfully (Fig 5). During the whole traction
period, there was no discomfort of patient and the tip of angiography
catheter was complete. Contrast was injected from the sheath to confirm
patency of the brachial artery. After 10 days’ follow up, there was no
discomfort in right upper limb of the patient.