Case Courtesy Dr. Eytan Raz
Normally, aortic arch variants are not kind to radial access aficionado. The angles are unfavorable. However, few great vessels can withstand the technical prowess of Dr. Raz! In this case of a questionable superior cerebellar artery vascular malformation in a patient with known right aberrant subclavian artery radial access was chosen as the principal question could be answered by catheterization of the right vertebral. However, a possible right carotid bifurcation abnormality also existed and access to that vessel was not a sure thing. As it turns out, right CCA was successfully catheterized via the aberrant subclavian approach. The left CCA could not, but we did not try much given our diagnostic goals.
MRA showing abnormal left Superior Cerebellar Artery
Source Images
Right radial approach
Right subclavian
Right vert injections. No arteriovenous shunt.
Aberrant Subclavian
A cheap man’s aortogram via a simple diagnostic catheter can often be good enough to see what you need to see without the pigtail. For example, here we can see a separate origin of left CCA — no “bovine arch”, unfortunately, as this variant favors radial catheterization
Access of the right CCA. Pretty neat, huh…
A right Carotid Web (white arrow). Notice contrast stagnation in late arterial phase (black arrows)
Lateral views
Forearm post catheterization. We like doing this to show this
Further reading
Aortic Arch Variants — A Guide to the Perplexed
