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Transradial approach scores over transfemoral approach as it is associated with less complications, mortality, and morbidity. Though right sided approach is more convenient for manipulating catheters and devices, aorto-subclavian tortuosity may result into looping, entrapment, kinking, and rarely intravascular knot formation. Here, we describe a case of a 60-year old female which had gone transradial catheterization from right side. Due to aorto-innominate tortuosity, excessive clockwise torque was applied to the catheter to cannulate right coronary artery which resulted into pressure damping, and intravascular knot formation in brachial artery. It was unravelled by counter clockwise rotation of catheter, and thus completing the procedure.

folia cardiologica

Intravascular knot as a complication of tortuosity at innominate-arch junction unravelled by counter-clockwise rotation- simple solution to complex problem