Successful Crossing of Complex Radial and Brachial Artery Anatomy Using a New Approach: Railtracking

Objective: Unusual clinical course Background: Use of the distal transradial artery (dTRA) for coronary angiography and PCI has been shown to be feasible and potentially has multiple advantages over proximal TRA regarding vascular complications, but when larger introducer sheaths (>6 Fr) are used, severe spasm and pain can be induced. However, in comparison with the more proximal part of the radial artery, the distal part is on average 0.5 mm smaller. As a consequence, when using dTRA, the use of slender techniques and miniaturization should be preferred to avoid a large sheathto-artery mismatch, which has unfavorable consequences. A new approach named RailTracking, using a conventional 6 Fr or 7 Fr guiding catheter and a vascular dilator (the Railway Sheathless Access System [RS] from Cordis Company), allows use of distal arterial access without need for a sheet introducer. Case Reports: We present 2 clinical cases with a difficult arterial access that were successfully managed using the RailTracking technique by dTRA access. In the first one, the conventional methods of arterial crossing failed because of the tortuosity and severe calcifications in the forearm and brachial artery. In the second case, the proximal TRA was occluded. Having arterial access on the dTRA and using the RailTracking allowed us to safely perform the interventions without need for vascular access site conversion. Conclusions: A new approach, RailTracking, which includes sheathless distal radial access and use of the RSS system could potentially decrease the vascular complications and facilitate the crossing, even in cases of complex vessels anatomy.