Reduction of catheter kinks and knots via radial approach.

Coronary angiography and percutaneous coronary intervention using the radial approach are becoming more frequent. Pronounced guide catheter manipulation in cases with tortuous access routes may lead to severe catheter kinking or knotting. The purpose of this review article is to present several techniques to resolve radial access catheter knots and kinks. First, simple maneuvers such as gentle traction, rotation, and guidewire advancement can often resolve minor kinking; however, complex loops and kinks are often not reversible with these simple maneuvers. Second, fixing the distal catheter tip using external compression, encasing the knot with a larger sheath, or untwisting the knot with hydraulic pressure can be useful. Finally, internal fixation by grasping the kinked catheter with a snare introduced via the femoral artery allows both ends of the catheter to be rotated in opposite directions to untwist the catheter for safe removal.