Case Report: An iatrogenic dissection of the aberrant right subclavian artery; think out of the box while doing radial angiography

Authors

  • Imrana Nawaz Punjab Institute of Cardiology, Lahore

DOI:

https://doi.org/10.55958/jcvd.v20i2.186

Abstract

We report a 40 years old male, laborer, non-smoker, non-diabetic, non-hypertensive. Admitted for diagnostic coronary angiography at Punjab Institute of Cardiology, Lahore via OPD. He was admitted about a month ago at emergency department and treated as NSTEMI (TIMI score = one) case during that admission and was discharged in stable condition with advice of Coronary angiography on OPD basis. His baseline Investigations were normal and Troponin I was positive and Echocardiography was also normal.

During coronary angiography, after doing left coronary system which was normal, right coronary catheter (JR4.0 5F) could not be advanced through the RSA due to the suspicion of subclavian artery. Therefore, patient was referred for CT angiography for the assessment of dissection and right coronary artery.

 

Discussion:

The aberrant right subclavian artery (ARSA) is the most common anomaly of aortic arch, occurring in 0.5 to 2% of individuals. 1 Lusoria comes from the Latin phrase "lusus naturae", meaning "freak of nature", which refers to the anomalous course of the artery. David bayford was the first one to describe dysphagia caused by an aberrant right subclavian artery, calling the clinical syndrome “Dysphagia lusoria” and the aberrant artery causing it “Arteria lusoria” forming a vascular ring around esophagus and trachea.

The course of aberrant right subclavian artery commonly 80% posterior to esophagus (as in our patient), 15% between esophagus and trachea and 5% anterior to trachea. There is Adachi-William's classification of aberrant right subclavian artery i.e, Type I : 4 branched pattern in the sequence of RCCA, LCCA,LSCA and ARSA, Type II: Similar to Type I but with additional branch left vertebral artery arising in between the origin of LCCA and LSCA, Type III: three branches that is Bicarotid trunk (common trunk of both common carotids), LSCA and ARSA.

Currently, there are no recommended guidelines on ARSA management. Various management options can be offered if patient is symptomatic that is surgery, percutaneous approach (TEVAR), hybrid approach (TEVAR + Carotid artery to subclavian Bypass). 2

 

Conclusion:

Coronary angiogram via right radial access in the presence of anatomical variations of great vessels is particularly challenging, as significant vessel tortuosity and abnormal catheter angulations may be encountered. So in diagnosed cases, left radial or femoral approach should be preferred.

References

Haouimi A, Aberrant right subclavian artery. Case study, Radiopaedia.org (Accessed on 14 Nov 2024) https://doi.org/10.53347/rID-98499

Jahangeer S, Bashir M, Harky A, Yap J. Aberrant subclavian: new face of an old disease. J Vis Surg. 2018 May 22;4:108. doi: 10.21037/jovs.2018.05.11. PMID: 29963397; PMCID: PMC5994462.

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Published

2025-01-17

Issue

Section

Case Report