Utility of balloon-assisted tracking in radial arterial access

Abstract

To the Editor, Currently, transradial approach is the most widely used access route both in coronary angiographies and percutaneous coronary interventions.1 However, it is not rare to find anatomical difficulties like severe spasm, small-caliber vessel, loops or tortuosities that cannot be overcome with the usual techniques and lead to access route changes eventually.2 In these situations, the advance of the catheter can dissect or perforate the artery and cause hematomas or even compartmental syndrome, although this entity is rare.3 As the main cause of resistance when advancing the catheter, Patel et al.4 identified the so-called razor effect exerted by the catheter distal border on the vessel wall (figure 1A), a mechanism that has been confirmed in optical coherence tomography studies.5 These same authors described the balloon-assisted tracking (BAT) technique4 that consists of inflating an angioplasty balloon that partially protrudes across the catheter distal border to keep its coaxial position with the artery avoiding the razor effect and providing better maneuverability (figure 1B). Therefore, the anatomical difficulty is crossed using a 0.014 in soft tip angioplasty guidewire. Afterwards, a 1.5 mm to 2.0 mm semicompliant balloon is inflated between 6 and 8 atm at the tip of the catheter and advanced en bloc...