Introduction. Congenital anomalies of the aortic arch, although numerous and
heterogeneous, occur in less than 1% of individuals at autopsies. Left aortic
arch with an aberrant right subclavian artery, also called arteria lusoria
dextra, is the most common anomaly of the aortic arch, occurring in 0.5-2.5%
of individuals. Case Outline. We report the case of a 48-year-old man
suffering from acute inferoposterior-wall ST elevation myocardial infarction
successfully treated by primary percutaneous coronary intervention. Ten years
ago, the patient had undergone coronary artery bypass graft surgery with the
implantation of two arterial grafts - left and right internal mammary
arteries on both left anterior descending and right coronary artery. After
several attempts to canulate truncus brachiocephalicus, angiogram revealed
the left aortic arch with the aberrant right subclavian artery. To our
knowledge, this is the first described case of primary percutaneous coronary
intervention via the aberrant right subclavian artery and right internal
mammary artery graft with stent implantation in the infarct related lesion of
the distal segment of right coronary artery. Subsequent 64-multidetector
computed tomography confirmed the angiographic findings. Conclusion. Early
recognition of congenital anomalies of the aortic arch and its great vessels,
even before coronary artery bypass graft surgery, could be crucial for the
urgent and successful treatment of patients with life-threatening conditions,
such as ST segment elevation myocardial infarction.
Percutaneous coronary intervention on bifurcation lesion through aberant right subclavian artery (a. lusoria)
