Be Aware of Aberrant Right Subclavian Artery Origin Before Aortic Coarctation Stenting: A Case Report Study

Abstract

The subclavian steal syndrome (SSS), also called subclavian steal steno-occlusive disease, is defined as reversal of the vertebral artery flow secondary to significant hemodynamically ipsilateral occlusion or stenosis of the proximal subclavian artery. It is usually seen secondary to atherosclerosis and aberrant right subclavian artery (ARSA), resulting in SSS which is even less common. Aberrant right subclavian artery is a kind of vascular anomaly associated with coarctation of the aorta (CoA). It usually originates from the descending aorta distal to the site of CoA. Here, we present a young man who was a case of ARSA and CoA. He developed SSS after transcatheter aortic stenting secondary to unusual origin of ARSA from the site of CoA. Awareness of this rare anomaly helps to overcome this complication in patients undergoing interventional stenting for CoA and ARSA with anomalous origin.

Hybrid Procedure for Coexistence of Coarctation of the Aorta and Aberrant Right Subclavian Artery: A Case Report and Review of the Literature

“…The origin of the left subclavian artery is rarely reported and can be either proximal or distal to the CoA site. 6 Herein, we observed that the ARSA was located proximal to the CoA site, which is commonly seen in CoA. When the ARSA is located distal to the CoA, the right arm, and leg may be equally decreased, which may make the condition challenging to diagnose.…”

“…A few updated reports about treatment for concomitant CoA and ARSA have been published. [4][5][6]25 When planning a surgical intervention for CoA with ARSA, careful preoperative evaluation of the complete aortic arch anatomy must be performed. 26 CTA helps to identify the origin of both the subclavian arteries in relation to the coarctation, along with the origin of vertebral arteries, aneurysm degeneration, or concomitant arch anomalies.…”

“…Failure to accurately identify the origin of the right subclavian artery may lead to occlusion after stent placement and postoperative subclavian steal syndrome. 6 During TEVAR, revascularization of the left subclavian artery was recommended by the Society of Vascular Surgery for non-emergency TEVAR; however, this recommendation was based on low quality of evidence. 27 To date, no evidence has been collected to support routine revascularization of the left subclavian artery.…”

“…One percent of patients with CoA have concurrent ARSA. 3 A few previous reports have described both open and hybrid treatment strategies for concurrent CoA and ARSA; [4][5][6] however, every patient must be carefully examined for surgical planning, which depends on the site of coarctation and origin of both the subclavian arteries.…”

Cerebral Ischemia after Stenting of Coarctation of the Aorta

“…The physiopathology is still unknown. Dehghan et al [12] reported a case of a 32-year-old man who developed after a transcatheter aortic stenting symptoms of transient cerebral ischemia secondary to a complete occlusion of the origin of aberrant right subclavian artery (ARSA) which was originating at the site of coarctation. Color Doppler sonography revealed a retrograde flow through the rightside vertebral artery, indicating the subclavian steal syndrome.…”