1/ pt presents with sudden onset CP at home. Takes Tylenol and goes back to sleep. Wakes up in the AM with mild CP. Goes to outside hospital with near res of pain. Trop 5 on arrival. No EKG changes. Diag cath 🔽
3/ I decided to place on G2B3a and ship to me. Plans for #PCI 12-24 hours after Aggrastat marinate. Patient continues to have mild CP controlled with nitro. #EKG stable. This is image next morning.
4/ Did one run @PenVascular CatRX #AvoidNoReflow. Ballooned and stented. Pull back AL 75 guide at end to make sure ostium is good. Happy with the result! Sometimes waiting and using meds makes life easier! #TheMarinade
➡️Arteria Lusoria or aberrant right subclavian artery (ARSA) is the most common congenital arch anomaly in which the right subclavian artery originates from the descending aorta, distal to the left subclavian at the ductus arteriosus.
(2/)On its course towards the R arm, the aberrant vessel travels retrotracheal +retroesophageal. The prevalence of ARSA ranges from 0.6 to 1.4%. The prevalence of ARSA rises exponentially to 26–34% in individuals with Down syndrome and other chromosomal defects. Pic: @Tesslagra
(3/) Rarely, ARSA can accompany Kommerell's diverticulum, an aneurysm of the descending aorta at the origin of the ARSA. This can present clinically as dysphagia, dyspnea, or subclavian steal syndrome, often requiring surgical intervention