Aberrant Right Subclavian Artery And Common Carotid Trunk

Abstract

A 25 year old woman presented with headache and posterior circulation ischemic strokes. Non-invasive workup demonstrated
bilateral distal vertebral artery dissections. The patient underwent a cerebral angiogram for
further assessment. An aortic arch injection was performed due to following a challenging
supra-aortic vessel catheterization (Figure-1) demonstrating an aberrant right subclavian
artery and common carotid trunk.
A left aortic arch with an aberrant right subclavian artery is one of the most frequent
anatomical variations of the aortic arch. This anomaly has been reported in about 0.5% of
the general population.1
Furthermore, in up to 20-30% of these cases there is an associated
common carotid trunk 2, 3 as shown in our case. Less frequent is the association of a common
subclavian trunk.4
The third and fourth pairs of primitive aortic arches in the embryo build up the aortic arch
system. The third pair gives rise to both carotid arteries, initially with a common trunk.
The persistence of this stage explains a common origin variant. An aberrant right subclavian
artery occurs when the right fourth arch and the proximal right dorsal aorta abnormally regress