1Prof. Bassem Yousef Sheikh



The community of Neurointerventional world is mostly in total agreement on the significant advantages of transradial approach as compared to transfemoral approach. However, the neurointerventionest showed be aware of anatomical variations that may render this approach rather difficult or riskier. Arteria lusoria, Aberrant right subclavian artery, is one of these variations that render catheter shaping and reforming to navigation into the cranial vasculature challenging. It has an incidence of 0.6–1.4%.

We are presenting a series of cases of neurovascular pathologies that were managed by endovascular techniques via the transradial approach in the presence of Arteria lusoria. The technical challenges and nuances in overcoming them are illustrated.

Material(s) and Method(s):

Method: Case series of hospital-based population on neuro endovascular procedures, that were managed via the transradial approach in the presence of Arteria lusoria.


Total of 362 transradial approach for different neurovascular pathology were managed in Madinah region, Saudi Arabia, since 2017. Out of these, eight cases were having Arteria lusoria. Management included thorough preoperative investigation, including arch imaging on CT angiography or MR angiography. Approach strategies included ipsilateral transradial approach, or contralateral left side approach. In all but one case, the endovascular procedure was completed successfully. In one case the approach was converted to transfemoral.


Our results confirm the feasibility of utilizing the transradial approach in neuroendovascular procedures provided the case was fully investigated and the anomaly is thoroughly studied preoperatively