# Severe Radial Artery Spasm Causing Radial Artery Sheath Entrapment: A Case Report

## TL;DR

This case report describes a severe radial artery spasm during a coronary angiography procedure and the successful treatment method used to remove the sheath.

## Contribution

The paper presents a novel approach using a blood pressure cuff to manage radial artery sheath entrapment caused by severe spasm.

## Key findings

- Severe radial artery spasm can lead to sheath entrapment during coronary angiography.
- A blood pressure cuff inflated above systolic pressure helped relax the artery and remove the sheath safely.
- Traditional medications failed to alleviate the spasm in this case.

## Abstract

Over the past decade, there has been a significant increase in the use of the transradial approach in patients undergoing coronary angiography due to lower risk of complications and quicker recovery. Nevertheless, radial artery spasm remains a challenge, particularly in anxious men and women, and young female patients. Transradial access is associated with a significantly lower bleeding risk compared to transfemoral access. The radial artery is predisposed to significant spasms as it has a smaller caliber and is highly sensitive to mechanical and humoral stresses compared to femoral artery. We present the case of an 82-year-old male who was transferred from a district general hospital for coronary angiography and developed severe spasm in the right radial artery at the end of the procedure, resulting in radial artery sheath entrapment. We administered 600 microgram of intra-arterial nitrates, 2.5 mg intra-arterial verapamil, 3.5 mg midazolam, and 2.5 mg intravenous morphine with no effect on the spasm. Following this, we applied a blood pressure cuff and inflated it to 156 mmHg, which was 40 mmHg greater than his systolic blood pressure, for five minutes to occlude the brachial artery. This resulted in smooth muscle relaxation facilitating the removal of radial sheath without any adverse outcomes.