Ha K, Jang AY, Shin YH, Lee J, Seo J, Lee SI, Kang WC, Suh SY. Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery: A case report. World J Clin Cases 2022; 10(27): 9897-9903 [PMID: 36186178 DOI: 10.12998/wjcc.v10.i27.9897]
Corresponding Author of This Article
Soon Yong Suh, MD, PhD, Associate Professor, Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 1198, Namdong-gu, guwol-dong, Incheon 21565, South Korea. mrsue74@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Sep 26, 2022; 10(27): 9897-9903 Published online Sep 26, 2022. doi: 10.12998/wjcc.v10.i27.9897
Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery: A case report
Kyungeun Ha, Albert Youngwoo Jang, Yong Hoon Shin, Joonpyo Lee, Jeongduk Seo, Seok In Lee, Woong Chol Kang, Soon Yong Suh
Kyungeun Ha, Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea
Albert Youngwoo Jang, Yong Hoon Shin, Joonpyo Lee, Jeongduk Seo, Woong Chol Kang, Soon Yong Suh, Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
Seok In Lee, Department of Thoracic and Cardiovascular Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Incheon, South Korea
Author contributions: Ha K and Jang AY reviewed the literature and contributed to manuscript drafting, writing, editing, and revising; Kang WC and Suh SY were the patient’s interventionists contributed to manuscript drafting; Lee SI performed the surgical treatment consultation; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Soon Yong Suh, MD, PhD, Associate Professor, Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 1198, Namdong-gu, guwol-dong, Incheon 21565, South Korea. mrsue74@gmail.com
Received: May 6, 2022 Peer-review started: May 6, 2022 First decision: May 30, 2022 Revised: June 25, 2022 Accepted: August 16, 2022 Article in press: August 16, 2022 Published online: September 26, 2022
Abstract
BACKGROUND
Aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the aortic arch. When patients having such anomalies receive transradial intervention (TRI), aortic dissection (AD) may occur. Herein, we discuss a case of iatrogenic type B AD occurring during right TRI in an ARSA patient, that was later salvaged by percutaneous angioplasty.
CASE SUMMARY
A 73-year-old man presented to our hospital with intermittent chest pain. Coronary computed tomography (CT) angiography revealed significant stenosis in the left anterior descending artery. Diagnostic coronary angiography was performed via the right radial artery without difficulty. However, we were unable to advance the guiding catheter past the ostium of the right subclavian artery to the aortic arch for percutaneous coronary intervention, while the guidewire tended to go down the descending aorta. The patient suddenly complained of chest and back pain. Emergent CT aortography revealed type B AD propagating to the left renal artery (RA) with preserved renal perfusion. However, after 2 d, the patient suddenly complained of right lower limb pain where the femoral pulse was suddenly undetectable. Follow-up CT indicated further progression of dissection to the right external iliac artery (EIA) and left RA with limited flow. We performed percutaneous angioplasty of the right EIA and left RA without complications. Follow-up CT aortography at 8 mo showed optimal results.
CONCLUSION
A caution is required during right TRI in ARSA to avoid AD. Percutaneous angioplasty can be a treatment option.
Core Tip: Aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the aortic arch. When patients having anomalies undergo transradial intervention (TRI), aortic dissection (AD) may occur. Herein, we present a case of iatrogenic type B AD occurring during right TRI in an ARSA that was treated with percutaneous angioplasty.
