Preventing Kinks and Entrapments in Coronary Interventions With Innovative Approaches.

OBJECTIVE

To describe a novel balloon-assisted intraluminal technique for the removal of a kinked catheter during transradial coronary angiography complicated by subclavian artery tortuosity.

KEY STEPS: Catheter kinking was recognized during transradial access, refractory to standard maneuvers. A retrieval attempt with snare via femoral access failed. Using multiangle fluoroscopy, a 0.014-inch BMW guide wire (Abbott) was advanced through the kinked catheter lumen. Inflation of a 2.0-mm low-profile balloon within the kinked segment provided intraluminal support. Slow inflation of the balloon allowed controlled traction and smooth catheter removal without adverse effects.

POTENTIAL PITFALLS: Vessel damage or catheter breakage may occur if aggressive manipulation is attempted without intraluminal support. Precise fluoroscopic documentation of wire placement is essential. Operator expertise is paramount; escalation from simple to complex techniques should be followed. Attention to patient selection, catheter choice, and real-time imaging reduces risk.

TAKE-HOME MESSAGES: Proper catheter handling, minimized manipulation, and device selection are crucial. Operator expertise ensures safe, efficient outcomes.