Answer

While suspecting a thromboembolic event and in order to restore adequate coronary flow, the operator decided to urgently perform manual aspiration, which retrieved an approximately 40-mm structure compatible with radial artery endothelial tissue (Fig. 1). After pre-dilatation with a 2.5 × 15-mm semi-compliant balloon, a 3.5 × 23-mm drug-eluting stent was implanted, with no residual stenosis and TIMI grade flow 3. Radial artery pulse was absent after sheath removal, but distal perfusion to the hand was not compromised.

Fig. 1
figure 1

Endothelial tissue manually aspired from the left obtuse marginal artery

Full size image

Radial artery avulsion is a rare complication of transradial access in coronary angiography [1]. Moreover, embolisation of radial endothelial tissue to a coronary artery is an even more unlikely event. Radial avulsion is usually related to sheath withdrawal or spasm with guiding catheter entrapment and vessel trauma caused by its tip [2]. This can be prevented by decreasing artery spasm with careful selection and crossing of guiding catheters, as with intra-arterial administration of vasodilators. Artery avulsion is also more common in small-calibre and tortuous arteries [3]. Pre-procedural Barbeau or Allen tests are advisable in order to prevent more serious complications like hand ischaemia.