Discussion
In this case both Profit Plus 6 Fr RU and Profit plus 6 Fr JR 4.0 (advancing from right radial artery access) guide catheter were kinked in her tortuous right axillary artery during PCI.
Kinked catheters are thought to be the cause of artery injury that causes intramural hematoma. It has been reported that hematoma is often absorbed and dissipated spontaneously. However, in this case, the hematoma did not decrease and the true lumen was pressed upon.
It has been reported that the use of Amplatz-shaped catheters is a risk factor for catheter-induced coronary artery dissection(4), but the association between the type of catheter and artery injury in the upper limb is still unclear.
The JR catheter is preferred for operability; however, severe vessel tortuosity may be complicated by axillary artery occlusion(5). Arterial tortuosity is associated with older age, female sex, high blood pressure, and other cardiovascular risk factors(6). For such cases, an operator should never push against resistance or cause excessive catheter torqueing(7). Prompt changes in arterial access should also be considered to prevent iatrogenic catheter-inducing complications.