Spasm of the radial artery is the most important cause of failure to perform coronary angiography via the transradial approach. Spasmolytic cocktail may prevent radial artery spasm but is relatively contraindicated in patients with aortic stenosis or diminished left ventricular function. In this case report we describe a recently published technique to overcome severe radial spasm during transradial coronary angiography in a patient with moderate aortic valve stenosis. 1. Introduction After a two-decade evolution, the transradial approach (TRA) in coronary angiography and percutaneous coronary intervention (PCI) has become a viable and attractive alternative for the femoral approach [1–4]. The increased adoption of the TRA originates from high procedural success, reduced risk for major access site related bleeding complications, lower mortality, increased patient comfort, and cost reduction [5–7]. One of the most encountered problems is radial artery spasm. In a multicenter registry containing over 1900 transradial procedures, the incidence of radial spasm was 2.7%, with multiple puncture attempts and use of larger introducer sheaths (7F) being independent predictors of radial spasm [8]. Another prospective study reported female gender as an independent contributor to the incidence of radial spasm [9]. Furthermore, spasm can be triggered by excessive manipulation of intra-arterial wires and guides, especially if there is some mismatch in diameter between a small radial artery and a large bore catheter. Radial artery spasm can be prevented by administration of intraarterial spasmolytic cocktails [10]. However, in some instances these cocktails may result in hypotension and bradycardia. Patients with a significant aortic stenosis have a fixed stroke volume and therewith are at high risk of refractory and life threatening hypotension after administration of spasmolytic cocktail. In this case report, we describe a recently published technique [11] to overcome severe radial spasm in a patient with moderate to severe aortic valve stenosis who underwent TRA coronary angiography. 2. Case A 70-year-old male patient was referred for coronary angiography because of chest pain on exertion. In preceding years, he visited our outpatient department for echocardiographic follow-up of a moderate aortic valve stenosis. During the last visit he expressed typical anginal complaints while echocardiographic evaluation of the aortic valve displayed a stable function. Patient underwent coronary angiography via right radial access. After uneventful puncture and cannulation of a
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