Diagnostic coronary angiography – routine procedure, unexpected event
█ Case report
Sasi Viktor, Havasi Kálmán, Szántó Gyula, Forster Tamás, Nemes Attila, Ungi Imre
Szegedi Tudományegyetem, Általános Orvostudományi Kar, II. sz. Belgyógyászati Klinika és Kardiológiai Központ, Szeged
A patient diagnosed with significant aortic valve stenosis was admitted to the University Clinic for mandatory examinations prior to surgical aortic valve replacement. Echocardiography confirmed the initial diagnosis. There was 107 mmHg peak and 60 mmHg mean gradient over the aortic valve and aortic valve area was 0.9 cm2. Coronary angiography was planned. Coronary angiography was performed with 5F diagnostic Judkins left and right catheter from the radial approach as a standard at our institute. After uneventful puncture, initial left coronary system angiography was carried out without any difficulty. During long manipulation with the JR catheter in the right coronary cusp we could visualize a “knob” formation in the ascending aorta on the catheter. This knob could not be unraveled with wires. We tried to extract the ruined diagnostic catheter with a three dimensional kinking on it, but due to its size and vasospasm it was impossible. We tried different innovative tricks, but at the end we got close to the stuck catheter from the opposite direction with a gooseneck snare, grabbed it, pulled it into the brachial artery and with stretching rotation and twisting the knob unraveled. After letting go of the catheter it could easily be retracted from the initial puncture site. The angiography of the right arm showed no dissection or closure of any vessel involved during the procedure. Follow up ultrasounds have shown the same result during the course of institutional stay.