Case 111: Manual of CTO Interventions: Radial spasm and sequential troubleshooting

A patient was referred for PCI of a right coronary artery CTO. Radial and femoral access were selected, however the patient developed severe radial artery spasm, refractory to vasodilators, heavy sedation, propofol, and Rotaglide administration. A blood pressure cuff was inflated in the right arm, resulting in ischemia-induced vasodilation and successful withdrawal of the entrapped guide catheter. A second femoral arterial was obtained, followed by antegrade crossing attempts that resulted in crossing into an acute marginal branch.Retrograde crossing attempts via septal collaterals failed. A guidewire and microcatheter were advanced via an epicardial collateral from the circumflex but failed to cross retrograde. Repeat antegrade crossing attempts led to subintimal crossing into the right posterolateral, followed by re-entry into the true lumen using the "stick and swap technique" and the retrograde guidewire as a marker. The RCA was successfully recanalized.

[@tuanhoanh1198]

in radial spasm, sometimes I found that "razor technique" may help operator. 1/3 distal part of balloon is out of guiding catheter while the other is inside the guide. The balloon is inflated at normal pressure and advance the whole system. I don't know how about the value of this technique but this save me in several situations

[@mohamedkishkt3667]

any information about Dyevert system?

[@manosbrilakis]

Please see attached link to a recent paper we published: www.invasivecardiology.com/articles/use-dyevert-system-chronic-total-occlusion-percutaneous-coronary-intervention