Facilitating wire advancement into the ascending aorta during right radial cardiac catheterization by instructing turning the head to the left in a tortuous subclavian artery. Second case report

Coronary angiography and cardiac catheterization using the right radial arterial access have lower complication rates but are associated with unique challenges that can lead to procedural failure. One of the major challenges can be the wire advancement into the ascending aorta with a tortuous subclavian artery, particularly in the case of arteria lusoria. The deep inspiratory maneuver can help navigate the guiding wire into the ascending aorta. However, in extreme tortuosity or the case of arteria lusoria, it can be very difficult to advance the wire in the ascending aorta. In this manuscript, the second successful case of guide wire advancement in the ascending aorta in a very tortuous subclavian artery is described by instructing the patient to move her head to the left. This maneuver will straighten the subclavian artery, thus facilitating wire advancement into the ascending aorta by reducing the tortuosity of the subclavian artery. This can save radial cardiac catheterization and prevent changing the access route. This report describes this easy-to-perform maneuver in a difficult case of severe subclavian tortuosity, enabling us to complete the right radial cardiac catheterization.