Case
An 88-year-old woman with a history of critical limb ischemia and a chief complaint of intermittent chest pain since 3 days was transported to the emergency room. ST elevation in leads III and aVF was displayed on an electrocardiogram, and laboratory data showed elevation of Troponin I (442 pg/mL). Emergency coronary angiography (CAG) through right radial artery access was performed, but her right axillary artery was so tortuous that a 6 Fr guide catheter (Profit Plus®️ RU) and Profit plus 6 Fr JR 4.0 got kinked in it. Therefore, we changed the right femoral artery access. CAG showed right coronary artery stenosis, and we placed two drug-eluting stents (Ultimaster 3.5 mm×15 mm, 4.0 mm×15 mm) in her stenotic lesion.
Her chest pain improved after PCI, but she complained of slight pain in her right hand during the procedure. We prescribed acetaminophen, but her symptoms did not resolve. On the next day, the patient felt numbness and exhibited impaired skilled movement in the right arm. Physical examination showed nonpalpable right radial and brachial pulses, indicating advancing ischemia. We performed three-dimensional computed tomographic angiography, which revealed an obstructive lesion from the axillary artery to the brachial artery. Therefore, we decided to perform urgent revascularization (Figure 1,2).