Sealing the neck: a new balloon-based non-surgical solution to a well-known radial artery complication: a case report.

Background: Radial artery pseudoaneurysm is rare but its management is challenging, especially in patients on potent blood thinner medication. Conventional treatments have limitations, including patient discomfort, embolic risk, or the need for surgical repair. Case summary: A 93-year-old woman underwent urgent percutaneous coronary intervention (PCI) for inferior ST-elevation myocardial infarction (STEMI) via the right radial artery (RA) with a 7F Slender® sheath. Forty-eight hours later, a small-neck pseudo-aneurysm developed at the puncture site. Ultrasound-guided compression failed. Via ipsilateral distal radial access (DRA), angiography delineated the neck, and a 2.5 mm semi-compliant balloon was inflated across it for 10 min under ultrasound monitoring. Thrombus formation occurred, and final angiography confirmed exclusion with radial artery patency. At 30 days, Doppler showed persistent patency and a small isolated residual cavity. At 3 months, the pseudoaneurysm had resolved with a fibrotic remnant and asymptomatic radial artery occlusion. Discussion: Balloon angioplasty across the neck of a small-neck radial artery pseudo-aneurysm via DRA is an effective, minimally invasive option for rapid thrombosis and definitive closure. It may be useful in selected cases, although late radial artery occlusion should be taken into account.