Abstract
We report a case of right cerebral insufficiency in a 65-year-old woman with right aortic arch with mirror-image branching. The patient was found to have intermittent occlusion at the origin of the right common carotid artery between the aortic arch and the sternoclavicular joint. Duplex showed intermittent bizarre carotid artery waveforms directly related to patient positioning. The patient underwent a transposition of the right common carotid to the right subclavian artery with subsequent resolution of symptoms. Right aortic arch with mirror-image branching can rarely present with right cerebral insufficiency due to intermittent mechanical occlusion of the right common carotid artery.
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