Yet more knots in the radial artery, unravelling purely by counter clockwise rotation.

We describe here two more radial knots that could be unravelled by counter-clockwise rotation alone. We and others have previously described radial knots that occur when trying to engage the right coronary artery (RCA). Here, we show two knots that were unravelled purely by counter-clockwise rotation. One occurred during RCA catheterisation and the other occurred during left coronary angiography via the radial route. In one of the patients, severe pain occurred in the right shoulder. This occurred even though the artery was not in spasm. We were able to move the catheter. Therefore it is possible that pain combined with the ability to move the catheter may be a marker of an intravascular knot.