Pushing wrist access to the limit: homolateral right ulnar artery approach for primary percutaneous coronary intervention after right radial failure due to radial loop

Abstract

A 67-year-old man underwent primary percutaneous coronary intervention for acute anterior ST elevation myocardial infarction. The right radial artery was the access of choice. After easy cannulation, a 360-degree loop was found at the elbow level. The brachial artery and a large ulnar artery were visible by injecting contrast through the radial loop. After an unsuccessful attempt to engage the loop, the operator switched entry site for the homolateral ulnar artery. Leaving the radial sheath in place, the cannulation of the ulnar artery was successful and uncomplicated. The operator could easily perform a successful intervention of the culprit vessel. An angiogram of the wrist, via the ulnar sheath showed the presence of a big interosseous artery with flow up to the hand and no flow in the radial and ulnar arteries distal to the sheaths. The ulnar and radial arteries were successfully sealed after a few hours, a valid pulsation was present on both arteries and no signs of ischemia were evident in the right hand the day after.