Successful coil embolization of pericardiacophrenic artery perforation occurring during transradial cardiac catheterization via right radial artery

The transradial approach for percutaneous coronary intervention (PCI) has gained increasing popularity as an alternative site for coronary angiography and intervention. The transradial approach has safely been used in patients with contraindications to the transfemoral approach. Despite its overall lower complication rates compared with the transfemoral approach, the transradial approach has its own inherent complications. The risk of arterial perforation with the transradial approach is less than 1%, primarily involving the radial artery with the incidence of compartment syndrome at approximately 0.004%. In addition, the risk of significant bleeding requiring transfusion with transradial approach is extremely rare, occurring in about 1/1000 patients. In this report, we present a case of pericardiacophrenic artery perforation occurring during wire advancement into the aorta via right radial artery approach, which was treated with coil embolization for treatment of significant hemorrhage. This case emphasizes the importance of recognizing this artery in order to prevent similar complications in the future. This artery can be confused with the aorta, since it has a similar course paralleling the aortic arch, and as such it can be inadvertently mistaken for the ascending aorta during wire advancement.