Navigatinga Hostile Subclavian Loopduring Trans-Radial Angiography

Hostile anatomy of the subclavian artery (severe tortuosity and/or heavy calcification) remains a significant obstacle for the trans-radial approach during coronary angiography and interventions. Herein we report a case of trans-radial angiography with a hostile subclavian loop which could not be negotiated by .035 Terumo wire, extra stiff Amplatz wire, balloon assisted tracking [BAT] technique and was ultimately negotiated by buddy wire technique with a .014 coronary wire and Amplatz extra stiff wire.