title: Primary percutaneous coronary intervention in a patient with right internal mammary artery graft originating from arteria lusoria dextra.
abstract: BACKGROUND
  Congenital aomalies of the aortic arch, although numerous and heterogeneous, occur in less than 1% of individuals at autopsies. Left aortic arch with an aberrant right subclavian artery, also called arteria lusoria dextra, is the most common anomaly of the aortic arch, occurring in 0.5-2.5% of individuals.
  
  
  METHODS
  We report the case of a 48-year-old man suffering from acute inferoposterior-wall ST elevation myocardial infarction successfully treated by primary percutaneous coronary intervention.Ten years ago, the patient had undergone coronary artery bypass graft surgery with the implantation of two arterial grafts- left and right internal mammary arteries on both left anterior descending and right coronary artery. After several attempts to canulate truncus brachiocephalicus, angiogram revealed the left aortic arch with the aberrant right subclavian artery. To our knowledge, this is the first described case of primary percutaneous coronary intervention via the aberrant right subclavian artery and right internal mammary artery graft with stent implantation in the infarct related lesion of the distal segment of right coronary artery. Subsequent 64-multidetector computed tomography confirmed the angiographic findings.
  
  
  CONCLUSIONS
  Early recognition of congenital anomalies of the aortic arch and its great vessels, even before coronary artery bypass graft surgery, could be crucial for the urgent and successful treatment of patients with life-threatening conditions, such as ST segment elevation myocardial infarction.
authors.affiliation: University of Belgrade, Serbia.
authors.forename: Srdjan
authors.initials: S
authors.lastname: Aleksandrić
authors.forename: Siniša
authors.initials: S
authors.lastname: Stojković
authors.forename: Miloje
authors.initials: M
authors.lastname: Tomašević
authors.forename: Jelena
authors.initials: J
authors.lastname: Kostić
authors.forename: Marko
authors.initials: M
authors.lastname: Banović
authors.forename: Nemanja
authors.initials: N
authors.lastname: Menković
authors.forename: Miodrag
authors.initials: M
authors.lastname: Ostojić
mesh_terms: D000783:Aneurysm; D015906:Angioplasty, Balloon, Coronary; D001013:Aorta, Thoracic / Q000002:abnormalities; D018376:Cardiovascular Abnormalities; D001026:Coronary Artery Bypass; D003680:Deglutition Disorders; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery; D012008:Recurrence; D013348:Subclavian Artery / Q000002:abnormalities* / Q000637:transplantation