Mechanical Thrombectomy for Medium-Vessel Occlusion with a Right-Sided Aortic Arch: A Case Report.

Abstract

Objective: A right-sided aortic arch is a rare vascular anomaly, and neuroendovascular therapy through the right-sided aortic arch is extremely rare. Herein, we report the case of a patient with a right-sided aortic arch who performed a mechanical thrombectomy for medium-vessel occlusion.

Case presentation: An 84-year-old woman could not respond to her family during a conversation at 8:50 am. She was brought to our hospital at 10:30 am on the same day. A diffusion-weighted image of head magnetic resonance imaging revealed a high-intensity area in the left temporal lobe. Head magnetic resonance angiography revealed a loss of the inferior trunk of the left middle cerebral artery. A mechanical thrombectomy was performed. The guiding catheter ascended on the right side from the midline, and the patient was considered to have a right-sided aortic arch. Selecting the left common carotid artery was difficult due to its unusual origin from the ascending aorta. Internal carotid angiography revealed left temporo-occipital artery occlusion. Mechanical thrombectomy was performed using Solitaire X 3× 20 mm (Covidien, Irvine, CA, USA), and recanalization was achieved. Contrast-enhanced chest and abdominal computed tomography revealed a right-sided aortic arch with an aberrant left subclavian artery. She was transferred to a recovery hospital with a modified Rankin Scale score of 1.

Conclusion: Understanding the branching patterns and classifications of the right-sided aortic arch is necessary for physicians performing mechanical thrombectomy.