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Primary percutaneous coronary intervention in a patient with right internal mammary artery graft originating from arteria lusoria dextra

Aleksandrić Srđan (Medicinski fakultet, Beograd + Klinički centar Srbije, Klinika za kardiologiju, Beograd)
Stojković Siniša (Medicinski fakultet, Beograd + Klinički centar Srbije, Klinika za kardiologiju, Beograd)
Tomašević Miloje (Medicinski fakultet, Univerzitet u Kragujevcu, Kragujevac, Srbija; Klinika za kardiologiju, Klinički centar Kragujevac, Kragujevac, Srbija;)
Kostić Jelena (Medicinski fakultet, Beograd + Klinički centar Srbije, Klinika za kardiologiju, Beograd)
Banović Marko (Medicinski fakultet, Beograd + Klinički centar Srbije, Klinika za kardiologiju, Beograd)
Menković Nemanja (Medicinski fakultet, Beograd + Centar za radiologiju i magnetnu rezonancu, Klinički centar Srbije, Beograd)
Ostojić Miodrag (Medicinski fakultet, Beograd + Klinički centar Srbije, Klinika za kardiologiju, Beograd)

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.

Keywords: arteria lusoria dextra, aberrant right subclavian artery, ST elevation myocardial infarction, percutaneous coronary intervention, congenital aortic arch anomalies, radial approach