Coronary Angiography in Patients with Arteria Lusoria via Right Radial Access
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Tanawan Riangwiwat, M.D.
,
Geisinger Medical Center, Danville, PA
Nath Limpruttidham, MD, MPH
,
University of Hawaii Internal Medicine Residency Program, Honolulu, HI
Tayebah Mumtaz, MD
,
Geisinger Medical Center, Danville, PA
James C. Blankenship, M.D., MSCAI
,
Geisinger Health System, Danville, PA
Background
Transradial is the access of choice for coronary angiogram (CAG) since it is proven to have less complication. Arteria lusoria (AL), which has a prevalence up to 3%, poses a challenge for transradial access since it can cause difficulty in accessing the ascending aorta. The success rate for radial access in patients with AL is unknown.
Methods
We performed a retrospective review of electronic health records of patients who underwent CAG in Geisinger Medical Center from January 1996 to November 2018.
Results Among 45,857 CAG cases, we identified 4 with AL undergoing right radial access. All were successful. Case 1: A 51 year old man presented with NSTEMI. After multiple attempts, a Judkins curved left (JCL) 3.5 guide catheter was able to cross to ascending aorta. The left coronary artery (LCA) and the right coronary artery (RCA) were engaged with a 5 Fr Judkins left (JL) 4 and a 5 Fr Judkins Right (JR) 4 catheter. For percutaneous intervention (PCI), the JL 4 was used to engage LCA. Three years later CAG via left radial access was done. Coronary ostia were engaged by a 6 Fr JCL 3.5 and a 5 Fr JR 4. Two years later, right radial approach CAG was performed. A 5 Fr JL 3.5 and a 5 Fr JR 4 were used. An Extra BackUp (EBU) 3.5 guide catheter was used to engage LCA for PCI. Case 2: A 53 year old man presented with pulmonary edema and found to have depressed ejection fraction. The CAG via right radial artery using a 5 Fr JL 3.5 and a 5 Fr JR 4 showed no coronary artery disease. Case 3: A 66 year old man with diabetes mellitus presented with unstable angina. Coronary arteries were engaged with a 5 Fr JL 4 and a 5 Fr JR 4. Case 4: A 77 year old man presented with unstable angina. Transradial CAG was done using a 5 Fr Tiger catheter for both RCA and LCA.
Conclusions The prevalence of AL in patients undergoing CAG at our center is much less than the reported prevalence. This suggests that many AL patients are unidentified at the time of CAG. CAG can be successfully performed using right radial access in patients with AL, without unusual effort in many patients. Details of the procedures are similar to data from CAG via the right radial in patients without AL. Left radial access may offer a straighter route when the diagnosis is known.
