Published online Sep 26, 2022. doi: 10.12998/wjcc.v10.i27.9897
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
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.
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.
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.