DISTAL TRANSRADIAL APPROACH IN HIGH-RISK PATIENT WITH STEMI AND CARDIOGENIC SHOCK – A CASE REPORT

Abstract

Conventional transradial access has been considered as a recommended choice in PCI and myocardial revascularization.The vascular complications such as radial artery occlusion, perforation and spasm have led to the development of a new approach, which was proposed to overcome these limitations. This was a distal transradial approach (snuffbox approach). A 74-year-old woman presented to the emergency department with oppressive chest pain and dyspnea formore than 3 hours.On clinical examination, the patient appeared pale and diaphoretic, with weak and rapidpulsation and systolic blood pressure below 70mmHg. A 12 lead ECG lead was performed, whichshowed ST segment elevation of 4 mm in inferior lead.She was admitted to the catheterization laboratory with blood pressure 70/40mmhg andnorepinephrine vasopressor support. A 6Fr introducer sheath was placed in distal radial (anatomical snuffbox). The coronary angiography revealed RCA with acute total occlusion and high thrombotic burden TIMI 5 in proximal segment,normal LMCA, LAD and Circumflex. RCA was engaged with a guide catheter and advanced distally a floppy guidewire, then the occlusion site was predilated with a balloon and advanced stent from proximal segment with TIMI3 final flow. 2D transthoracic echocardiography was performed, and it showed heart failure with mildly reduced ejection fraction and hypokinesia of the inferior wall. Distal transradial access is a new approach which might offer several advantages over conventional radial access such as reduction of the risk of radial artery occlusion, short hemostasis andsaving the radial artery for possible future coronary artery graft.