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360-degree radial loop negotiated by a novel maneuver.

469 Video S1). The loop was traversed with an an‐ gioplasty wire (0.14‐inch), as the conventional 0.35‐inch guide wire failed (Figure 1B; Supplemen‐ tary material, Video S2), but we were unable to advance the guiding catheter. Using balloon‐ ‐assisted tracking, the guiding catheter was suc‐ cessfully negotiated (Figure 1C; Supplementary ma‐ terial, Video S3), but the loop failed to straight‐ en. It was eventually straightened with a gentle counterclockwise rotation (Figure 1D–1F; Supplemen‐ tary material, Videos S4 and S5) and the cathe‐ ter was successfully delivered to the aortic root to complete the procedure. Balloon ‐assisted tracking is a well ‐described technique that aids in negotiating anatomical obstacles in the radial and brachial arteries. However, this is the first report on a 360‐de‐ gree radial loop negotiated by a combination of balloon ‐assisted tracking and counterclockwise rotation to straighten it. The shaft of the bal‐ loon provided the adequate support to perform the maneuver of counterclockwise rotation to The transradial approach for percutaneous coro‐ nary intervention significantly reduces the risk of bleeding complications and mortality as com‐ pared with the transfemoral access. However, certain anatomical variants can pose a great challenge, which may result in a failure to com‐ plete the procedure and compel the operators to switch the access site to the femoral artery, con‐ tralateral radial artery, or even ipsilateral ulnar artery.1‐3 A radial loop is one such obstacle that is associated with the highest failure rates among all anatomical variants.1,2 Even if it is negotiated with guidewires, straightening of the loop can be challenging. Without this, it is difficult to com‐ plete the procedure and catheter knotting may occur, which is likely to be catastrophic and may require surgical intervention.4 Here, we report the case of a 360‐degree ra‐ dial loop that was encountered while under‐ taking complex distal left main angioplas‐ ty in a 78‐year ‐old woman via the right radi‐ al approach (Figure 1A; Supplementary material, Correspondence to: Sandeep Basavarajaiah, MD, MrCP, FeSC, Department of Cardiology, Heartlands Hospital, university Hospitals of Birmingham, Bordesley green, B9 5SS Birmingham, united Kingdom, phone: +44 1214247478, email: sandeep270478@gmail.com Received: December 30, 2020. Revision accepted: February 20, 2021. Published online: March 5, 2021. Kardiol Pol. 2021; 79 (4): 469‐470 doi:10.33963/KP.15865 Copyright by the Author(s), 2021 C L I N I C A L V I G N E T T E