JACC: CARDIOVASCULAR INTERVENTIONS VOL. 11, NO.

22, 2018

ª 2018 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

PUBLISHED BY ELSEVIER

IMAGES IN INTERVENTION

Successful Percutaneous Coronary

Intervention in a Double Aortic Arch
With a Right Descending Aorta
Usefulness of 3-Dimensional Computed Tomography
Angiography

Yusuke Sato, MD, Tetsuji Morishita, MD, PHD, Hiroyasu Uzui, MD, PHD, Hiroshi Tada, MD, PHD

A 77-year-old man was admitted to our hospi-

tal with
failure. The
chest pain and
electrocardiogram
ST-segment changes in the precordial leads, and
acute heart
exhibited
therapeutic challenge in this patient. Femoral and
left radial approaches were not available because of
severe descending aorta tortuosity and an obliter-
ated left aortic arch. A right transradial approach
transthoracic echocardiography revealed severe was chosen for percutaneous coronary intervention
anterior-septal wall hypokinesis. A chest x-ray (PCI) because the right aortic arch served as the
demonstrated a right-deviated aorta (Figure 1A). Cor- main channel. The patient underwent an uneventful
onary computed tomography angiography (CTA) PCI (Figures 1G to 1I).
revealed a double aortic arch (DAA) and right A double aortic arch (DAA) is a very rare congenital
descending aorta, combined with severe left anterior malformation characterized by the presence of 2
descending artery stenosis. The aorta, after crossing aortic arches. To the best of our knowledge, this is the
retroesophageally, turned sharply back to the left first case of PCI using CTA in a DAA with a right
and caudally, descending on the left (Figures 1B to descending aorta. Three-dimensional CTA estab-
1F, Online Video 1). The right aortic arch was normal lished the DAA diagnosis and enabled an exact
size and served as the main systemic channel, description of the anatomy and comprehensive un-
whereas the left persisted as a partially obliterated derstanding of the vascular rings, which were essen-
tube. Determining the approach site was the tial for pre-PCI planning.

From the Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan. The authors
have reported that they have no relationships relevant to the contents of this paper to disclose.

Manuscript received July 20, 2018; accepted August 30, 2018.

ISSN 1936-8798/$36.00 https://doi.org/10.1016/j.jcin.2018.08.032

e186 Sato et al. JACC: CARDIOVASCULAR INTERVENTIONS VOL. 11, NO. 22, 2018

PCI in a Patient With a Double Aortic Arch NOVEMBER 26, 2018:e185–6

F I G U R E 1 3-Dimensional CTA of the DAA and Pre- and Post-Intervention CAG

(A) The chest x-ray showed a right-deviated aorta. (B to F) Computed tomography angiography (CTA) and 3-dimensional CTA: The right aortic
arch (red arrowheads) was normal size and served as the main systemic channel. The left aortic arch (yellow arrows) persisted as a partially
obliterated tube. The left anterior descending coronary artery presented with severe stenosis (white arrow). See Online Video 1. (G) A 6-F Ikari
left 3.5 guiding catheter was used to cannulate the left coronary ostium via right radial artery access. (H) Coronary angiography (CAG) of the
left coronary artery. (I) Post-stented CAG of the left coronary artery. AP ¼ anteroposterior; CRA ¼ cranial; RAO ¼ right anterior oblique.

ADDRESS FOR CORRESPONDENCE: Dr. Tetsuji KEY WORDS computed tomography angiography, double aortic arch,
percutaneous coronary intervention
Morishita, Department of Cardiovascular Medicine,
Faculty of Medical Sciences, University of Fukui, 23-3
Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, A PPE NDI X For a supplemental video, please see the online version
Fukui 910-1193, Japan. E-mail: tmori@u-fukui.ac.jp. of this paper.