# Successful right transbrachial cerebral angiography in a patient with aberrant right subclavian artery: A technical note

## TL;DR

A patient with an unusual blood vessel structure successfully underwent a specific type of brain imaging using a challenging technique.

## Contribution

Demonstrates successful cerebral angiography via the right transbrachial approach in a patient with aberrant right subclavian artery.

## Key findings

- Right transbrachial CAG was successfully performed despite the presence of aberrant RSCA.
- The Simmons curve technique enabled bilateral common carotid artery cannulation without switching to a transfemoral approach.
- Early detection of aberrant RSCA is crucial for successful RTBA CAG.

## Abstract

Aberrant right subclavian artery (RSCA) is a congenital anomaly in which the RSCA arises as the final branch of the aortic arch, the presence of which makes cerebral angiography (CAG) via the right transbrachial approach (RTBA) difficult to perform. Herein, we present a case of aberrant RSCA in which the right transbrachial CAG was successfully executed and review its technical details in consideration of the anatomy of the aberrant RSCA. A 51-year-old man was admitted to our hospital with an unexplained subcortical hemorrhage in the left parietal lobe. Diagnostic CAG was performed via the RTBA, leading to the diagnosis of aberrant RSCA. Despite some technical difficulty, the Simmons curve was formed at an acute angle between the aberrant RSCA and the aortic arch. Once the Simmons curve is formed, torque control of the catheter can result in the bilateral common carotid artery (CCA) cannulation without switching to a transfemoral approach. Left CCA angiography confirmed an arteriovenous fistula in the distal left anterior cerebral artery. Subsequently, the suspected source of intracerebral bleeding and associated hematoma were surgically resected. Early detection of aberrant RSCA is crucial when using the RTBA. Depending on the procedure of catheterization, the right transbrachial CAG can be performed even in patients with aberrant RSCA; therefore, its continued usage seems worthy of consideration after setting a time limit.