Abstract
Owing to vascular malformations, it is difficult to perform catheter operation following the radial artery approach in percutaneous coronary intervention for acute ST-segment elevation myocardial infarction (STEMI) with Kommerell’s diverticulum on the right-sided aortic arch. However, only few studies have reported the use of the femoral artery approach to achieve early reperfusion; however, there is no established approach for patients with a right-sided aortic arch. In this study, we retrospectively analyzed the usefulness of the femoral artery approach in patients with STEMI and a right-sided aorta from January 2010 to March 2021.The total number of computed tomography (CT) cases was 180,514, of which 2 involved STEMI. In one of the two cases, the right radial artery approach was used. Therefore, only one patient with STEMI with a right-sided aortic arch underwent and operation using the femoral artery approach. In this patient, early revascularization was achieved with a door-to-balloon time of 70 min, suggesting the usefulness of the femoral artery approach.
Highlights
Kommerell’s diverticulum is defined as >50% extension of the distal segment, which is found in 20%-60% of aberrant subclavian arteries that branch from the left or right side of the aorta 1,2).In a surgical and radiology series, a right-sided aortic arch with an aberrant left subclavian artery is reported to have an incidence between 0.04% and 0.4% 1).In Kommerell’s diverticulum, 15% of cases with coronary artery disease have been reported; details are yet to be elucidated[2]).Currently, there are a few reports of ST-segment elevation myocardial infarction (STEMI) in Kommerell’s diverticulum with a right-sided aortic arch 4).Early revascularization with a goal of a 90-min door-to-balloon time is important for improving the prognosis of patients with STEMI3)
Revascularization with a goal of a 90-min door-to-balloon time is important for improving the prognosis of patients with STEMI3)
In PCI for STEMI with Kommerell’s diverticulum on the right-sided aortic arch, catheter operation is difficult to perform following the radial artery approach because of vascular malformations4).only few studies have reported the use of femoral artery approach to achieve early reperfusion, and no approach has been established as being appropriate for patients with a right-sided aortic arch
Summary
Revascularization with a goal of a 90-min door-to-balloon time is important for improving the prognosis of patients with STEMI3). In PCI for STEMI with Kommerell’s diverticulum on the right-sided aortic arch, catheter operation is difficult to perform following the radial artery approach because of vascular malformations[4]).only few studies have reported the use of femoral artery approach to achieve early reperfusion, and no approach has been established as being appropriate for patients with a right-sided aortic arch.
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