Author + information
- Received June 6, 2018
- Accepted June 12, 2018
- Published online December 17, 2018.
- Dinu Valentin Balanescu, MDa,
- Cinzia Moncalvo, MDb,
- Teodora Donisan, MDa,∗ (, )
- Paolo Cioffi, MDb,
- Cezar Iliescu, MDa and
- Serban Mihai Balanescu, MD, PhDc
- aDepartment of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
- bCardiovascular Department, Centro Cuore, Policlinico di Monza, Alessandria, Italy
- cDepartment of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- ↵∗Address for correspondence:
Dr. Teodora Donisan, Department of Cardiology, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, Texas 77030.
- aberrant right subclavian artery
- self-expanding stent(s)
- thoracic outlet syndrome
A 40-year-old woman complaining of worsening right arm claudication was admitted for diagnostic work-up. Computed tomography angiography revealed innominate artery agenesis, with both common carotid arteries emerging from the aortic arch, and an aberrant right subclavian artery (ARSA) with an ostial atherosclerotic plaque causing 75% diameter stenosis (Figures 1A1 and 1A2). Coronary and carotid angiographies were normal. The ARSA lesion was treated with a flexible 8-mm × 20-mm Precise self-expanding nitinol carotid stent system (Cordis, Fremont, California), with good angiographic results (Figures 1B1 and 1B2, Online Videos 1 and 2). Due to clinical suspicion of thoracic outlet syndrome (TOS) based on a positive Adson’s sign, ARSA angiography was performed with the right arm in abduction, revealing mid-ARSA total flow obstruction and subsequent flow restoration in adduction (Figures 1B3 and 1B4, Online Video 3). Follow-up computed tomography angiography showed a well-positioned ARSA stent (Figures 1C1 to 1C3) and compression of the mid-ARSA between the clavicle and the first rib, diagnosing costoclavicular syndrome (Figures 1D1 to 1D3). Surgical removal of the first rib resulted in symptom resolution.
The simultaneous presence of TOS, ARSA, and atherosclerosis in a young woman is unusual. To the best of our knowledge, this is the first report of ARSA atherosclerosis and treatment with a self-expanding stent. Symptom onset due to ARSA (dysphagia, dyspnea, or cough) during adulthood is uncommon (1). Treatment is reserved for symptomatic or complicated cases (secondary to aneurysmal formation), generally with surgical or hybrid procedures (2). An association between ARSA and TOS has been reported, but literature data are limited (3).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 6, 2018.
- Accepted June 12, 2018.
- 2018 American College of Cardiology Foundation
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