WP

A 38-year-old male patient was diagnosed as acute non-ST-segment elevation myocardial infarction (NSTEMI) on Apr 21st 2021. He received PCI for RCA via transradial artery access (TRA) and took regular medication. He sought for second PCI in our center for frequently exertional angina on Sep 13th 2021. The patient’s height was 176cm, and his weight was 76kg. Right radial artery pulsation can not be touched, indicating right radial artery occlusion (RAO).

Procedure was conducted on Sep 14th 2021 via distal transradial artery access (dTRA) at location of snuffbox. Angiography confirmed RAO at right forearm (Fig 1A). Pilot 50 guidewire (Abbott, USA) andguiding catheter (St Jude Medical, USA) crossed occlusion after balloon pre-dilation(Fig.1B-1E). Coronary angiography showed significant stenosis in the distal leftmain artery (LM) and proximal-middle part of left anterior descending artery (LAD). Assisted with intravascular ultrasound (IVUS, 60MHz, BostonScientific, USA), two Resolute Integrity stents (Medtronic, USA) was implanted at lesions from mediumLAD to LM. Guiding catheter retracting, a Reewarm 2.5*220mm paclitaxel DCB (Endovastac,China) was released at 12 atm in radial arterial lesion with 90 seconds before 0.2mg nitroglycerin bolus (Fig.1F-1H, Fig.2A). Thrombi and limited dissection wereconfirmed with IVUS examination in right radial artery (Fig.2B-2E). Pulsationof radial artery can be well palpated 24 hours after PCI. No oral anticoagulantwas added. Ultrasoundexamination of right radial artery at 8-month and 14-month follow-up was showedin Fig 3A-3J. The right radial artery remained patent after treatment. Withintimal hyperplasia, the diameter of right radial artery was narrower than theother side at proximal 5cm to radial styloid process at 8-month follow-up (Fig.3C)and recovered at 14-month follow-up (Fig.3H). There is no abnormal sensation orobstacle of right hand.

Retrograde recanalization of radial artery from dTRA is proved to be an effective method to resolve RAO since 2011.However,high incidence of radial artery restenosis or re-occlusion can not be overcome with plain balloon.We improved the protocol applying paclitaxel DCB after RAO recanalization in thiscase. To our knowledge, this is the first case to intervene chronic RAO with DCB via dTRA. Although limited dissection after dilation, the blood flow recovered and the right radial artery remained patent till now. Intimal hyperplasia may be due to dissection and the follow-up will be continued to identify the long-period effect.