Percutaneous transluminal coronary angioplasty by right transradial approach in a patient with arteria lusoria.

Though the radial artery is an ideal site of access for coronary interventions, at times anatomical variations make this procedure complicated. We describe one such arterial aberrancy, the retroesophageal right subclavian artery or arteria lusoria, in which the right subclavian artery arises distal to the left subclavian artery. Therefore, approaching through the right radial artery, the catheter has to take a zigzag course through the right subclavian to the descending aorta, and then to the ascending aorta. This often makes it difficult to perform diagnostic angiography. Performing angioplasty by the right transradial approach also becomes a more difficult task and requires greater perseverance and skill. In the case described here, the patient with arteria lusoria had tandem 90% stenosis involving the proximal and mid left anterior descending artery. Percutaneous transluminal coronary angioplasty with stenting of the proximal and mid left anterior descending artery by the right transradial approach was performed, negotiating the loop with two paclitaxel-eluting stents.