PMC8086652_01
A. Inserted 6 Fr sheath via left snuffbox approach; B. Urgent coronary angiography (CAG) demonstrating thrombotic total occlusion in the proximal left anterior descending artery; C. CAG demonstrating successful primary percutaneous coronary intervention with drug-eluting stent implantation; D. No bleeding complication of puncture site after 3-hour hemostasis; E. Patient using a mobile phone without the inconvenience of puncture-side hand immediately after removal of sheath.
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Urgent coronary angiography (CAG) was performed via the left snuffbox approach using 6 Fr sheath (Fig. 1A) with loading of acetylsalicylic acid 300 mg and prasugrel 60 mg. After administration of 3000 units unfractionated heparin via sheath, CAG demonstrated total occlusion in the proximal left anterior descending artery (LAD) (Fig. 1B). Primary percutaneous coronary intervention (PCI) was successfully performed with a 3.25 x 23 mm everolimus-eluting stent after intracoronary bolus of abciximab (Fig. 1C). There was no puncture site complication after hemostasis for 3 h (Fig. 1D) and the patient did not complain about an inconvenience of finger or wrist movement in the puncture side hand after removal of the sheath (Fig 1E).
Snuffbox puncture sites in the anatomical snuffbox (blue box) and in the first intermetacarpal space (blue circle).
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As shown in Figure 2, there are 2 snuffbox puncture sites where well pulsation of the distal radial artery can be found.