Distal radial approach treating a left main lesion during hemostasis of the forearm radial artery on the same side in a case of unstable angina

Conventional radial access (cRA) for percutaneous coronary intervention (PCI) has become the current standard due to low bleeding complications, although recently, distal radial access (dRA) has attracted attention as an alternative. Here, the usefulness of dRA is shown in a case in whom neither side could be used for cRA. The patient was a woman in her 70 s diagnosed with unstable angina pectoris at another hospital. Although ad hoc PCI was attempted via her right forearm radial artery, her hemodynamics deteriorated and the procedure was abandoned. After an intra-aortic balloon pumping device was inserted via the left femoral approach and hemostasis was established with a dedicated device, the patient was transferred to our hospital. Her right radial artery was being used for hemostasis and her left radial artery was poorly palpable. Because her right distal radial artery was palpable, access via that location was attempted after confirming sufficient blood vessel diameter and blood flow by ultrasound. A 6Fr sheath was inserted and PCI was safely accomplished. Hemostasis on dRA was completed without complications using a hemostasis device. Thus, dRA may be an option as an alternative access site in an emergency. <Learning objective: Radial access is recommended by the guidelines for coronary intervention in order to prevent access site complications. We report a case of unstable angina successfully treated for a left main lesion via the distal radial artery during hemostasis of the forearm radial artery on the same side. Distal radial access, little considered for catheterization, may be an alternative option when conventional radial access cannot be employed. It is important to share this conclusion with all physicians.>