Radial Artery Spiral Dissection Confirmed by OCT Without Guidewire Shadow

J INVASIVE CARDIOL 2020;32(4):E102.

Key words: cardiac imaging, new technique, optical coherence tomography

A 75-year-old man underwent right transradial coronary angiography because of acute myocardial infarction. Postprocedural radial angiography revealed a dissection with a spiral luminal filling defect in the proximal radial artery corresponding to a National Heart, Lung, and Blood Institute type D dissection (Figure 1A; Video 1). In order to acquire a full, 360° optical coherence tomography (OCT) image, we withdrew the guidewire out of the sheath ahead of pullback and left the OCT imaging wire in the vessel alone. However, subsequent pullbacks were performed without any difficulties. Without the guidewire shadow, it was clear that the dissection started from a disruption of an intimomedial membrane (Figure 1K), which was outlined perfectly as a so-called “barbershop pole” by three-dimensional OCT (Figure 1B; Video 2). The false lumen extended along the long axis of the vessel (Figure 1G) by rotating clockwise from 7 o’clock to 4 o’clock at cross-sectional images (Figures 1C to 1K).

This is the first report of a novel attempt to eliminate the guidewire shadow artifact by removing the guidewire during frequent-domain OCT interpretation in vivo. We successfully observed a rare iatrogenic spiral dissection of a radial artery caused by transradial coronary intervention.

View the Supplemental Videos Here

From ¹the Division of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein. 

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted June 12, 2019.

Address for correspondence: Jincheng Guo, MD, Professor of Medicine, Division of Cardiology, Beijing Luhe Hospital, Capital Medical University, No. 82, Xinhuanan Street, Tongzhou District, Beijing, China. Email: guojcmd@126.com