Incidental finding of arteria lusoria during transradial coronary catheterization: Significance in interventional cardiology

Truncus Bicaroticus With Arteria Lusoria: A Rare Combination of Aortic Root Anatomy Complicating Cardiac Catheterization

While most patients with arteria lusoria and common carotid trunk conditions are asymptomatic, discovery of such anomalies periprocedurally may affect the cardiac catheterization access site, catheter selection, and additional imaging.

Iatrogenic aortic dissection following transradial coronary angiography in a patient with an aberrant right subclavian artery

An aberrant right subclavian artery is a congenital aortic arch anomaly in which the right subclavian artery originates from the proximal descending aorta. The presence of an aberrant right subclavian artery can make right transradial coronary interventions more difficult and even lead to complications. Iatrogenic intramural hematomas and dissection of aberrant right subclavian arteries during transradial coronary angiography have been previously reported. We herein report a case of iatrogenic aortic dissection following attempts to perform right transradial coronary angiography in a patient with an aberrant right subclavian artery. Clinicians should be vigilant for the presence of an aberrant right subclavian artery during right transradial coronary angiography and ensure gentle manipulation of wires and catheters to avoid complications.

Coronary Angiography in Patients with Arteria Lusoria via Right Radial Access: A Case Series and Literature Review

Transradial is becoming the access of choice for coronary angiography (CAG). Arteria lusoria (AL) poses a challenge for right transradial access because it can cause difficulty in accessing the ascending aorta. Of 18,686 patients who underwent CAG in Geisinger Medical Center from 2012 to 2018, 6 had a diagnosis of AL. Four underwent attempted right radial access, in 3 cases before AL was identified. All were successful, and one patient had successful right transradial percutaneous coronary intervention. CAG and PCI can be successfully performed using right radial access in patients with AL.

Coronary intervention and arteria lusoria-Not simple as it may seem

We reviewed the letter from Dr. Walter W. Woody and would like to thank him for showing his interest in our article and providing his opinion and point of view. However, we respectfully disagree with few points that have been raised. Switching to a femoral approach was considered to be a safer alternative for percutaneous intervention due to the presence of arteria lusoria. Risks and possible complications would include increased contrast use, increased radiation exposure, aortic dissection and even cerebral stroke, all of which have been reported extensively in literature. One single procedural methodology cannot be applied to a particular clinical scenario, whether simple or challenging. We have multiple different catheters and multiple different interventional approaches at our disposal to help and guide us through a case, in the best interest of the patient.