There's a complication of radial artery perforation in PCI, that is a rare but feared. Radial artery perforation tends to occur in tortuous anatomy or small vessels and can happen following the advancement of catheter. I thought using the hydrophilic-coated long radial sheath is benefit, so I report several cases that long radial sheath was practical for stenotic radial artery and prevented the injury of vessel, and could perform PCI.

After inserting short sheath into radial artery for CAG or PCI, we cross 0.035’’ spring J wire set in the catheter through the right radial artery. If any resistance or difficulty is felt upon spring J wire, radial artery angiography is conducted. In case of stenotic radial artery, it’s important to judge whether 5Fr or 6Fr catheter can advance or not with angiography referring to 5Fr catheter outer diameter is 1.67mm, 6Fr catheter is2.09mm as compared with 5Fr sheath is 1.78mm and 6Fr sheath is 2.10mm. If there is a possibility of vessel injury, we switch from short sheath to long sheath, and try to cross the stenosis with it. In all cases the long sheath could be crossed the narrowing port in our experiences.

For the purpose avoiding the radial artery perforation, the long sheath was extremely useful. The tip of sheath is tapered as compared with the guiding catheter is dull and the hydrophilic-coated, therefore the long sheath could be crossed the stenosis without injury. I recommend the long sheath should be always stocked in your catheter room.