Mediastinal haematoma complicating percutaneous coronary intervention via the radial artery

Michael Spies, Nigel Jepson, et al

The radial artery has been increasingly used worldwide as the preferred access site for diagnostic coronary angiography and percutaneous coronary intervention (PCI), owing to increased patient comfort and reduced risk of haemorrhagic complications when compared to the femoral approach. Despite being rare, catastrophic haemorrhage can occur and should be promptly recognised. We present an example of a case complicating coronary intervention from the radial approach resulting in a large mediastinal haematoma.

An 87-year-old female underwent PCI to the LAD via the right radial artery, on aspirin, clopidogrel and bivalirudin. A hydrophilic Glidewire® (Terumo Corp., Tokyo, Japan) was required to negotiate the tortuosity of the subclavian artery during passage of the 6 Fr EBU 3.5 guiding catheter (Medtronic, Minneapolis, MN, USA), with there being transient passage of the Glidewire into a branch of the right subclavian artery. The PCI procedure subsequently proceeded without any apparent complication.