Arteria Lusoria in a Patient With ST-Segment Elevation Acute Myocardial Infarction: Implications for Primary PCI

Abstract: Arteria lusoria is a rare aortic arch anomaly, with 1%-2% incidence. This image series documents the discovery of this anatomic variant in a patient who presented for primary percutaneous coronary intervention due to myocardial infarction. Awareness of this anomaly and subsequent rapid conversion to femoral access can reduce door-to-balloon time during primary PCI.

J INVASIVE CARDIOL 2015;27(6):E106

Key words: anomalous aortic arch, arteria lusoria

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Case Report

A 64-year-old man was referred for primary percutaneous coronary intervention (PCI) because of inferior ST-segment elevation acute myocardial infarction. Using right radial access, a 6 Fr Judkins right (JR) guide catheter was advanced into the right subclavian artery, but could not enter the ascending aorta. Angiography through the JR guide catheter revealed an aberrant right subclavian origin from the proximal posteromedial descending thoracic aorta with a retroesophageal course (ie, arteria lusoria) (Figures 1A and 1D). The right coronary artery was successfully recanalized via femoral access, restoring Thrombolysis in Myocardial Infarction 3 antegrade flow (Figures 1B and 1C). 

Arteria lusoria is a rare aortic arch anomaly (1%-2% incidence) with aberrant origin of the right subclavian artery from the proximal descending aorta distal to the left subclavian artery, and retroesophageal course in most patients.¹ Awareness of this anatomic variant and rapid conversion to femoral access (although transradial PCI can be successful in some cases)^1,2 can minimize delays in door-to-balloon time during primary PCI.

References

1. Valsecchi O, Vassileva A, Musumeci G, et al. Failure of transradial approach during coronary interventions: anatomic considerations. Cathet Cardiovasc Interv. 2006; 67:870-878. 
2. Quesada R, Kovacs M. Clinical case update. Transradial intervention for STEMI: complex anatomy and solution. J Invasive Cardiol. 2011(Suppl):1-4.

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From the Veterans Administration North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Khalili has no disclosures. Dr Banerjee reports research grants from Gilead and the Medicines Company; consultant/speaker honoraria from Covidien and Medtronic; ownership in MDCare Global (spouse); intellectual property in HygeiaTel. Dr Brilakis reports consulting/speaker honoraria from St. Jude Medical, Terumo, Asahi Intecc, Abbott Vascular, Elsevier, Somahlution, and Boston Scientific; research grants from Guerbet and InfraRedx; spouse is an employee of Medtronic.

Manuscript submitted December 9, 2014 and accepted December 12, 2014.

Address for correspondence: Emmanouil Brilakis MD, PhD, FACC, Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, 4500 South Lancaster Road (111A), Dallas, TX 75216. Email: esbrilakis@gmail.com