Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery:A case report  

作　　者：Kyungeun Ha Albert Youngwoo Jang Yong Hoon Shin Joonpyo Lee Jeongduk Seo Seok In Lee Woong Chol Kang Soon Yong Suh 

机构地区：[1]Division of Cardiology,Department of Internal Medicine,Yonsei University College of Medicine,50 Yonsei-ro,Seodaemun-gu,Seoul,South Korea [2]Division of Cardiology,Department of Internal Medicine,Gil Medical Center,Gachon University College of Medicine,Incheon,South Korea [3]Department of Thoracic and Cardiovascular Surgery,Gil Medical Center,Gachon University College of Medicine,Incheon,Incheon,South Korea

出　　处：《World Journal of Clinical Cases》2022年第27期9897-9903,共7页世界临床病例杂志

摘　　要：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.

关 键 词：Aberrant subclavian artery Coronary angiography Aortic dissection AORTOGRAPHY Percutaneous transluminal angioplasty Case report 

分 类 号：R543.1[医药卫生—心血管疾病]