When Not to Pull: Radial Artery Spasm, Catheter Entrapment, and the Value of Waiting
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J INVASIVE CARDIOL 2026. doi:10.25270/jic/26.00160. Epub June 4, 2026.
I read with great interest the case of radial artery eversion by Akcay et al.1 The authors present a rare and highly instructive complication. While this case is striking, it underscores a critical practical rule: in severe radial spasm, the safest strategy is often to wait rather than pull.
Radial artery spasm remains an important limitation of radial access and may occasionally lead to severe vascular injury.2 For nonurgent diagnostic coronary angiography, particularly in women or patients with suspected small radial arteries, a 4F or 5F system should be considered whenever feasible. The artery-to-sheath ratio is clinically relevant and has been associated with radial flow impairment and spasm.3 Therefore, routine use of a 6F sheath for a purely diagnostic procedure may be unnecessary when no ad hoc intervention is planned.
When catheter entrapment occurs, management should be deliberately conservative. Beyond standard first-line measures, including vasodilators, analgesia, sedation, and local warming,2,4 flow-mediated vasodilation with transient upper-arm cuff inflation may represent a useful rescue technique. Inflating a sphygmomanometer cuff above systolic pressure for several minutes, followed by rapid deflation, can promote reactive hyperemia and radial vasodilation.4,5 This maneuver may facilitate catheter or sheath removal and can be repeated cautiously, provided there is no evidence of limb ischemia, bleeding, or compartment syndrome.
Crucially, if the patient is stable and there is no vascular emergency, the entrapped catheter should be secured and left in place. Waiting several hours under adequate analgesia and sedation may allow the spasm to resolve spontaneously and prevent traumatic extraction. As this case illustrates, even “mild” traction against a tightly contracted artery can result in severe radial injury.
Ultimately, radial spasm should be treated as a true vascular event rather than mere procedural resistance. Smaller-caliber diagnostic systems and a stepwise approach to catheter entrapment may reduce the risk of irreversible radial injury.
Affiliations and Disclosures
Mehdi Rochd, MD
From the Department of Cardiology, University of Mons, Belgium.
Disclosures: The author reports no financial relationships or conflicts of interest regarding the content herein.
Address for correspondence: Mehdi Rochd, MD, Department of Cardiology, University of Mons, Bâtiment Pentagone, 25, Avenue Maistriau, Mons 7000, Belgium. Email: el.rochd@gmail.com
References
1. Akcay M, Balaban F, Danacı Kol N. Excessive force-induced eversion endarterectomy on the radial artery spasm: uncontrolled force is not force. J Invasive Cardiol. 2026;38(5). doi:10.25270/jic/25.00344
2. Sandoval Y, Bell MR, Gulati R. Transradial artery access complications. Circ Cardiovasc Interv. 2019;12(11):e007386. doi:10.1161/CIRCINTERVENTIONS.119.007386
3. Saito S, Ikei H, Hosokawa G, Tanaka S. Influence of the ratio between radial artery inner diameter and sheath outer diameter on radial artery flow after transradial coronary intervention. Catheter Cardiovasc Interv. 1999;46(2):173-178. doi:10.1002/(SICI)1522-726X(199902)46:2<173::AID-CCD12>3.0.CO;2-4
4. Roy S, Kabach M, Patel DB, Guzman LA, Jovin IS. Radial artery access complications: prevention, diagnosis and management. Cardiovasc Revasc Med. 2022;40:163-171. doi:10.1016/j.carrev.2021.12.007
5. Collet C, Corral JM, Cavalcante R, et al. Pressure-mediated versus pharmacologic treatment of radial artery spasm during cardiac catheterisation: a randomised pilot study. EuroIntervention. 2017;12(18):e2212-e2218. doi:10.4244/EIJ-D-16-00868
