Currently, the TRA has been recommended as a routine pathway for CAG and PCI [
1]. Compared with the femoral artery access, PCI via TRA can reduce the incidence of major cardiovascular adverse events and all-cause mortality in patients with acute coronary syndrome [
3,
4]. In recent years, RAO has become a common complication in the TRA, which has received increasing attention from interventional cardiologists. Research have shown that the incidence of RAO is 1%-12% [
5,
6] and can be as high as 30% [
7]. Many factors might be associated with RAO, such as female sex, DM, sheath size, operation time, low body mass index, long compression time, and repeated operation [
8]. Due to the dual blood supply, most patients suffering from RAO have no symptoms. However, RAO limits the utilization, such as for repeated CAG and PCI, of the radial artery, which is used as the bypass grafting and arteriovenous fistula vessel. Therefore, it has recently become increasingly important to repair RAO. For this case, it was a female with DM and long compression time, which might have contributed to the RAO. In addition, in our center, patients with AMI undergoing emergency PCI routinely retain the sheath for monitoring the intra-arterial pressure after procedure. It is also one of the causes of RAO, but it is our local practice and not widely adopted. We have recognized this problem. Recently, we routinely carried out coronary angiography and intervention via the dTRA in our center. The sheath was removed immediately after the procedure, and the hemostatic time was reduced to 3–4 h, which was significantly shorter than before.
In 2017, the dTRA was first described by Kiemeneij as the alternative access for cardiac catheterization [
2]. Since then, the safety and efficacy of CAG and PCI via the dTRA has attracted the attention of cardiologic interventionalists [
9‐
11]. At the same time, some studies have found that it was also safe and feasible to recanalize radial artery stenosis or occlusion via dTRA [
12‐
14]. In 2018, Schulte-Hermes et al. [
12] successfully performed angioplasty via dTRA in eight cases with severe radial artery stenosis. Sheikh AR et al. reported their successful experience in recanalizing the left RAO through the left dTRA [
13]. Under the guidance of vascular ultrasonography, Alkhawam H et al. successfully recanalized chronic RAO in a patient with acute myocardial infarction (AMI) [
14]. We first reported the recanalization of RAO via dTRA in a Chinese patient with AMI. In this case, because the RAO occurred recently, the thrombosis could not be absorbed through the sheath. Therefore, we could easily pass through the occluded segment by using a 0.014′’ guild wire during the operation and successfully complete the angioplasty. If the radial artery was occluded for a prolonged time, a strong guide wire might be used [
13]. Although the radial artery was occluded, pulsation of the distal radial artery could be appreciated in the AS due to the palmar arches and abundant lateral branches [
15]. Furthermore, we are experienced in distal radial artery puncture, which provided a guarantee for successfully repairing the RAO. As we know, the distal radial artery was smaller, which increased the difficulty of the puncture, and successful puncture was the first and the key step to ensure completion of the recanalization. To improve the success rate of distal radial artery puncture, we suggest that puncture should be carried out by experienced cardiologists under the guidance of vascular ultrasonography.