Radial Artery Spasm, Excision of Avulsed Fragment and Uncompromised Flow: An Oxymoron in Invasive Cardiology

A 63-year-old man with a history of smoking, panic attacks, and positive treadmill test was referred for invasive coronary angiography (CA). By a right radial artery (RA) approach, there was difficulty advancing the sheath and the standard guidewire. The patient complained of intense pain, anxiety, and discomfort. Fluoroscopy depicted severe RA spasm (RAS) (Figure 1A and Video Series). Prolonged occlusion flow-mediated dilation and balloon-assisted techniques failed. Sheath withdrawal avulsed an RA fragment (2 cm long) protruding through the access site (Figure 1B).