Two Cases of Acute Compartment Syndrome as Complication of Transradial Approach in STEMI: What Can Go Wrong and Lesson Learnt

Abstract

Background: Some studies showed the transradial approach (TRA) to be superior in terms of reducing bleeding complications and is related with lower 30-day mortality in patients with ST-elevation myocardial infarction (STEMI), while maintaining equal rates of TIMI 3 flow and procedural success. Nevertheless, TRA still present with a variety of complication, such as forearm hematoma and acute compartment syndrome, requiring a prompt surgical approach. Here, we present 2 cases of successfully managed acute compartment syndrome following primary Percutaneous Coronary Intervention (PCI) after STEMI.

Case Presentation: First patient, male, 42-year-old, transported to Siloam Diagram Heart Hospital with anterior STEMI with an onset of 6 hours. He has a history of hypertension and is an ex-smoker. Electrocardiography (ECG) shows elevation in ST segment leads V1-V4. The second patient, male, 62-year-old, came with an extensive STEMI with an onset of 13 hours. He is an active smoker with no history of chronic diseases. ECG shows RBBB and ST elevation in lead V2-V6, I, and aVL. Both underwent primary PCI procedures and developed forearm hematoma with compartment syndrome.

Management and Results: The first case was related to a laceration of the radial artery, and the second case was related to the compression band being positioned incorrectly in relation to the actual arteriotomy location. Both are successfully managed with a surgical approach with no neuromusculovascular sequelae.

Conclusion: CS might occur as a complication after the procedure caused by many conditions. Early recognition is essential to prevent neuromusculovascular complications.