The CAST technique: A novel capture-assisted Safari tracking maneuver for radial pigtail repositioning after TAVI

INTRODUCTION: Right radial access is increasingly used as the sole secondary arterial access during minimalist transcatheter aortic valve implantation (TAVI). However, unfavorable right subclavian-aortic arch angulation or marked supra-aortic tortuosity may prevent spontaneous advancement of a radial pigtail catheter into the descending aorta. TECHNIQUE: We describe the CAST (Capture-Assisted Safari Tracking) technique, a simple and reproducible maneuver for repositioning a radial pigtail catheter into the descending aorta using the Safari XS guidewire already in place during TAVI. The technique consists of four sequential steps: encounter, capture, pull-down, and release. The Safari XS guidewire acts as a traction rail, allowing the pigtail loop to be captured and guided in a controlled manner toward the descending aorta. RESULT: This maneuver enables successful repositioning of the pigtail catheter into the descending aorta despite unfavorable supra-aortic anatomy, without requiring additional arterial access or dedicated equipment. CONCLUSION: The CAST technique is a simple, reproducible, and equipment-free maneuver that can overcome selected difficulties encountered with radial access during minimalist TAVI. It may reduce repeated catheter and guidewire manipulation and avoid the need for additional femoral access.