The problem of arteria lusoria in right transradial coronary angiography and angioplasty

The retroesophageal right subclavian artery (arteria lusoria) is one of the anatomical abnormalities encountered by interventional cardiologists who p erform right transradial procedures. We report on 11 patients with arteria lusoria in whom 14 right transradial coronary angiography or angioplasty pr ocedures were attempted among a series of 3,730 consecutive right transradi al attempts. This abnormality can be easily detected by angiographic visual ization, in the anteroposterior projection, of the angle of the catheter wh en it engages the ascending aorta, and by manual angiography at the ostium of the right subclavian artery. In such a case, catheterization of the asce nding aorta may be difficult or even impossible (7.1%). Selective catheteri zation of both coronary arteries is more difficult, takes longer, and requi res more catheters. The Judkins catheters are recommended, although they ar e seldom used for the left coronary artery via the right radial approach, f or both arteries. All catheter exchanges should be performed on long guidew ires. (C) 2001 Wiley-Liss, Inc.