Severe Hand Ischemia Following Distal Transradial Coronary Intervention for Cardiac Arrest.

Background: Despite growing interest in the distal transradial approach (dTRA) for coronary interventions, the risk of hand ischemia remains insufficiently elucidated.

Case Presentation: A 72-year-old woman who experienced an out-of-hospital cardiac arrest was successfully resuscitated and diagnosed with acute myocardial infarction. Primary percutaneous coronary intervention was performed via dTRA with intra-aortic balloon pump support. Post-percutaneous coronary intervention, she developed systemic inflammatory response syndrome due to hypoperfusion during resuscitation, requiring high-dose norepinephrine, prolonged intra-aortic balloon pump support, and continuous renal replacement therapy. Ischemic changes gradually developed in her right thumb, which eventually became mummified and required amputation. Arteriography revealed radial artery occlusion and an incomplete superficial palmar arch.

Discussion: radial artery occlusion following dTRA carries a potential risk of severe hand ischemia, particularly in patients with complex post-percutaneous coronary intervention clinical courses.

Take-home Message: This case underscores the importance of vigilant monitoring for ischemic complications associated with dTRA in critically ill patients.