Clinical Case of Carotid and Coronary Artery Stenting by Distal Radial Access in a Patient with Arteria Lusoria

Introduction. The performance of interventional procedures on carotid and sometimes coronary arteries through radial access remains to be a challenging task. The presence of a. lusoria (a. l.) is an example of the complex anatomy of the aortic arch and its branches, which is considered to be a contraindication for interventions on the coronary and carotid arteries through radial access. In this study, an analysis of the intervention strategy for combined atherosclerotic lesions of the carotid and coronary arteries was carried out using a clinical case of a. l.

Materials and methods. Patient K., 56 years old, with multifocal atherosclerosis. Control angiography revealed an abnormal aortic arch with abnormal branches. The atherosclerotic lesions included a chronic occlusion of the right coronary artery (RCA) in the proximal segment with a significant stenosis of the right internal carotid artery.

Results and discussion. Given the significant difficulties in catheterising the right common carotid artery through a.l., it was decided to catheterise the left radial artery distally. To achieve reliable support of the guiding catheter, the Claret technique was used. To that end, a JR 7.5F (ASAHI) guiding catheter was remodeled into a Simmons catheter. To facilitate the selective catheterisation of the right common carotid artery, a Pigtail 5F diagnostic catheter was used as an extension (mother-child technique). The presented strategy enabled a successful catheterisation of the right common carotid artery, eventually allowing passing all the necessary instruments through the guiding catheter into the internal carotid artery to perform the intervention. The second stage was the recanalisation of a chronic occlusion of the right coronary artery. For RCA catheterisation, the left radial artery was chosen. A JFR 6F Adroit (Cordis) guiding catheter proved to be the most convenient. With its proper support, the RKA was re-canalised using a Gaia Third coronary guide (ASAHI). In order to determine the position of the guide in the RCA distal part, a contrasting was performed from the LCA system. After the RCA re-canalisation, stents with an antiproliferative coating were implanted with a good angiographic result.

Conclusion. The described clinical case and technical solutions allow endovascular care through radial access to be provided to patients with abnormalities of the aortic arch.

1. Galimov O.V., Plechev V.V., Ishmetov V.S., Abdrakhmanov R.E., Ibragimov T.R., Blagodarov S.I., et al. Possibilities of endovascular surgery in the treatment of visceral branches aneurysis. Vestnik of the Russian Scientific Center of Roentgenoradiology of the Ministry of Healthcare of the Russian Federation. 2017;17(2):7 (In Russ.).

2. Marchenko A.V., Myalyuk PA., Vronskiy A.S. A clinical case of multifocal atherosclerosis 4-step treatment using hybrid technologies. Kreativnaya Kardiologiya. 2016;10(2):184-90 (In Russ.). DOI: 10.15275/kreatkard.2016.02.08

3. Naiden T.V., Bartosh-Zelenaya S.Y., En’kina T.N., Abramov E.A. Ultrasound diagnostic compared with angiography of carotid arteries in the diagnosis of multifocal atherosclerosis. Regional blood circulation and microcirculation. 2015;14(1):20-5 (In Russ.). DOI: 10.24884/1682-6655-2015-14-1-20-25

4. Ognerubov N.A., Antipova T.S. Aberrant right subclavian artery (arteria lusoria): a case description. Tambov University Reports. Series: Natural and Technical Sciences. 2017;22(6):1473-7 (In Russ.). DOI: 10.20310/1810-0198-2017-22-6-1473-1477

5. Plechev V.V., Ishmetov V.Sh., Abdrakhmanov R.E., Ibragimov T.R., Kashaev M.Sh., Gerasimenko E.N., et al. Staged endovascular treatment of acute coronary syndrome and aortic valve stenosis in a patient with high risk of surgical intervention on the “open" heart. Bashkortostan Medical Journal. 2019;14(1):36-42 (In Russ.).

6. Semitko S.P., Melnichenko I.S., Karpeeva M.I., Bolotov PA., Analeev A.I., Azarov A.V., et al. The rate of symmetric complex anatomy of the arms’ arteries in the conversion from the right to the left radial approach, assessed by the data of the open registry COMPAAS (COMPlex Anatomy of Arteries and Symmetry). Consilium Medicum. 2019;21(5):92-8 (In Russ.). DOI: 10.26442/20751753.2019.5.190429

7. Sobirov Zh.G., Bakhritdinov F.Sh. Assessment of severity of lesions of arterial basins in patients with multifocal atherosclerosis. Angiology and Vascular Surgery. 2017;23(1):136-41 (In Russ.).

8. Sumin A.N., Korok E.V., Gaifulin R.A., Bezdenezhnykh A.V., Ivanov S.V., Barbarash O.L. Gender-specific features of the prevalence and clinical manifestations of multifocal atherosclerosis. Klinicheskaya Medicina. 2014;92(1):34-40 (In Russ.).

9. Il’icheva E.A., Zharkaya A.V., Bulgatov D.A., Borichevskaya M.A., Krunina E.Yu., Makhutov V.N. Preoperative diagnosis arteria lusoria in thyroid surgery. Siberian Medical Journal (Irkutsk). 2018;154(3):25-9 (In Russ.).

10. Sumin A. N., Bezdenezhnykh A. V., Ivanov S. V., Barbarash O.L., Bar-barash L.S. Multifocal atherosclerosis in patients with ischemic heart disease: Effect on immediate outcomes of coronary bypass. Russian Heart Journal. 2014;75(1):11-7. DOI: 10.18087/rhj.2014.1.1889

11. Khafizov R.R., Khafizov T.N., Idrisov I.A., Abkhalikova E.E. Successful application of left radial access for stenting the right internal carotid artery in a patient with multifocal atherosclerosis: A case report. Circulation Pathology and Cardiac Surgery. 2019;23(2):80-5 (In Russ.). DOI: 10.21688/1681-3472-2019-2-80-85

12. Chernykh A.V., Yakusheva N.V., Vitchinkin V.G., Zakurdaev E.I., Kosy-anchuk N.M. Case Report of Aberrant Right Subclavian Artery (Arteria Lusoria). Journal of Anatomy and Histopathology. 2015;4(2):68-70 (In Russ.). DOI: 10.18499/2225-7357-2015-4-2-68-70

13. Patel T., Shah S., Pancholy S. Patel’s Atlas of Transradial Intervention. [S.l.]: Hmp Communications; 2012. 242 p.

14. Rafiq A., Chutani S., Krim N.R. Incidental finding of arteria lusoria during transradial coronary catheterization: Significance in interventional cardiology. Catheter Cardiovasc Interv. 2018;91(7):1283-6. DOI: 10.1002/ccd.27439

15. Nobrega-Pinto A., Carvalho I., Almeida-Sousa C. Arteria lusoria: a rare cause of tracheal compression. Acta Otorrinolaringol Esp. 2018;69(2):120-1. DOI: 10.1016/j.otorri.2017.04.004

16. Thompson J.L., Burkhart H.M. Translocation of an aberrant right subclavian artery with resolution of dysphagia lusoria. Ann Thorac Surg. 2016;102(1):e65-7. DOI: 10.1016/j.athoracsur.2016.02.073

17. Jalaie H., Grommes J., Sailer A., Greiner A., Binnebosel M., Kalder J., et al. Treatment of symptomatic aberrant subclavian arteries. Eur J Vasc Endovasc Surg. 2014;48(5):521-6. DOI: 10.1016/j.ejvs.2014.06.040

18. Dimitroglou Y., Loulakas I., Chounti M., Megalakakis M., Karavana E., Hountis P. Unusual symptomatic late onset presentation of aberrant right subclavian artery: report of two cases and short literature review. Monaldi Arch Chest Dis. 2017;87(1):774. DOI: 10.4081/mon-aldi.2017.774