Wygięcie cewnika typu „pętli kobry” w obrębie odejścia tętnicy bezimiennej od łuku aorty w trakcie cewnikowania z dostępu przez tętnicę promieniową — fluoroskopowe wskaźniki tętnicy błądzącej

The retroesophageal right subclavian artery (ROSRA; arteria lusoria) is one of the anatomical abnormalities encountered at innominate-arch junction during transradial catheterization by right route. Here, we report a case of a 49-year old female who presented with chronic stable angina (Canadian Cardiovascular Society class-III) despite guideline directed medical treatment. Coronary arteries were cannulated with difficulty showing critical lesion of proximal left anterior descending artery (LAD). During angiography, diagnostic catheter has a peculiar cobra loop in the ascending aorta. As the left subclavian artery also has critical lesion at the proximal part, percutaneous coronary intervention of proximal LAD artery was successfully performed with 3.5×23 mm Xience Prime Everolimus eluting stent (Abott, USA) through right femoral route. Multi detector computed tomography (MDCT) contrast aortography showed the origin of the right subclavian artery in the right posterior side of the horizontal aorta with a tortuous course, proximal stenosis of left subclavian artery (LSC), and a bicarotid truncus. This abnormality can be easily detected by angiographic visualization, in the anteroposterior projection, of the angle of the catheter when it engages the ascending aorta, and by manual angiography at the ostium of the right subclavian artery. In such a case, selective catheterization of both coronary arteries may be very difficult, time consuming, and require more catheters. In such cases, one should not be hesitant to switch to transfemoral route if left radial route cannot be utilised.