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This case report describes an 84-year-old woman with medium-vessel occlusion and impaired responsiveness, whose imaging showed left temporal lobe diffusion restriction and loss of the inferior trunk of the left middle cerebral artery. Mechanical thrombectomy was performed using Solitaire X, achieving recanalization despite challenging catheter selection caused by aberrant vessel origins.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/mechanical-thrombectomy-for-medium-vessel-occlusion-with-a-right-sided-aortic-arch-a-case-report/395282/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/mechanical-thrombectomy-for-medium-vessel-occlusion-with-a-right-sided-aortic-arch-a-case-report/395282.png","ImageObject",300,407,{"name":92,"@type":93},"eBook King","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-26",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is mechanical thrombectomy through a right-sided aortic arch considered rare?","Question",{"text":113,"@type":114},"A right-sided aortic arch is a rare congenital vascular anomaly, and neuroendovascular access using this branching pattern has seldom been reported. The unusual anatomy makes catheter navigation particularly challenging.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What key imaging results supported the diagnosis and target occlusion?",{"text":118,"@type":114},"Diffusion-weighted MRI showed a high-intensity area in the left temporal lobe. Magnetic resonance angiography revealed loss of the inferior trunk of the left middle cerebral artery, indicating medium-vessel occlusion.",{"name":120,"@type":111,"acceptedAnswer":121},"How was the thrombectomy performed and what was the outcome?",{"text":122,"@type":114},"An 8-Fr system was advanced from the right femoral artery, and thrombectomy was performed using Solitaire X 3×20 mm without rt-PA given the uncertain onset time. Recanalization was achieved, and the patient was transferred with a modified Rankin Scale score of 1.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},395282,1790679057,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962088006270,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Online November 23, 2024  \nJournal of Neuroendovascular Therapy 2025; 19: 2024-0094 DOI: [10.5797/jnet.cr.2024-0094](10.5797/jnet.cr.2024-0094)  \nMechanical Thrombectomy for Medium-Vessel Occlusion with a Right-Sided Aortic Arch: A Case Report  \nSeigo Kimura, 1 Ryokichi Yagi,2 Akiko Marutani, 1 Fumihisa Kishi,3 Daiji Ogawa, 1 Keiichi Yamada, 1 Hirokatsu Taniguchi, 1 and Masahiko Wanibuchi2  \nObjective: A right-sided aortic arch is a rare vascular anomaly, and neuroendovascular therapy through the right-sided aortic arch is extremely rare. Herein, we report the case of a patient with a right-sided aortic arch who performed a mechanical thrombectomy for medium-vessel occlusion.  \nCase Presentation: An 84-year-old woman could not respond to her family during a conversation at 8:50 am. She was brought to our hospital at 10:30 am on the same day. A diffusion-weighted image of head magnetic resonance imaging revealed a high-intensity area in the left temporal lobe. Head magnetic resonance angiography revealed a loss of the inferior trunk of the left middle cerebral artery. A mechanical thrombectomy was performed. The guiding catheter ascended on the right side from the midline, and the patient was considered to have a right-sided aortic arch. Selecting the left common carotid artery was difficult due to its unusual origin from the ascending aorta. Internal carotid angiography revealed left temporo-occipital artery occlusion. Mechanical thrombectomy was performed using Solitaire X 3× 20 mm (Covidien, Irvine, CA, USA), and recanalization was achieved. Contrast-enhanced chest and abdominal computed tomography revealed a right-sided aortic arch with an aberrant left subclavian artery. She was transferred toa recovery hospital with a modified Rankin Scale score of 1.  \nConclusion: Understanding the branching patterns and classifications of the right-sided aortic arch is necessary for physicians performing mechanical thrombectomy.  \nKeywords▶ mechanical thrombectomy, medium vessel occlusion, right-sided aortic arch  \n Introduction  \nA right-sided aortic arch is a rare vascular anomaly that occurs during embryologic development. 1) A left-sided  \n1Department of Neurosurgery, Kouzenkai Yagi Neurosurgical Hospital, Osaka, Osaka, Japan  \n2Department of Neurosurgery and Endovascular Therapy, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan  \n3Department of Neuroendovascular Therapy, Osaka City General Hospital, Osaka, Osaka, Japan  \nReceived: September 26, 2024; Accepted: November 12, 2024 Corresponding author: Seigo Kimura. Department of Neurosurgery, Kouzenkai Yagi Neurosurgical Hospital, 2-12-13 Higashiimazato, Higashinari-ku, Osaka, Osaka 537-0011, Japan  \nEmail: [seigo.kimura@ompu.ac.jp](seigo.kimura@ompu.ac.jp)  \nThis work is licensed under a Creative CommonsAttribution-NonCommercialNoDerivatives International License.  \n©2025 The Japanese Society for Neuroendovascular Therapy  \naortic arch is formed by the left fourth aortic arch and left dorsal aorta.2–4) Aright-sided aortic arch is formed by complete occlusion between the left fourth aortic arch and left dorsal aorta, leaving the right fourth aortic arch and right dorsal aorta.5,6) The incidence of a right-sided aortic archis 0.04%–0 . 14% worldwide.5,6) A right-sided aortic arch is a rare vascular anomaly, and neuroendovascular therapy through the right-sided aortic arch is extremely rare. Furthermore, with the miniaturization of MT devices, favorable outcomes of endovascular therapy for medium-vessel occlusion (MeVO) have been reported in recent years.7,8) Herein, we report the case of a patient with a right-sided aortic arch who performed a mechanical thrombectomy for MeVO.  \n Case Presentation  \nThe patient was an 84-year-old woman who was last found to be healthy on the day before admission at 18:00 pm. Her family spoke to her at 8:50 am on the day of admission,  \nFig. 1 (A, B) Diffusion-weighted image of head magnetic resonance imaging on arrival rev","cbCaiirBwXDhJVBr","https://ap.wps.com/l/cbCaiirBwXDhJVBr","pdf",1474079,"English","# Objective\n# Case Presentation\n## Imaging findings\n## Mechanical thrombectomy procedure\n# Conclusion\n# Introduction","[{\"question\":\"Why is mechanical thrombectomy through a right-sided aortic arch considered rare?\",\"answer\":\"A right-sided aortic arch is a rare congenital vascular anomaly, and neuroendovascular access using this branching pattern has seldom been reported. The unusual anatomy makes catheter navigation particularly challenging.\"},{\"question\":\"What key imaging results supported the diagnosis and target occlusion?\",\"answer\":\"Diffusion-weighted MRI showed a high-intensity area in the left temporal lobe. Magnetic resonance angiography revealed loss of the inferior trunk of the left middle cerebral artery, indicating medium-vessel occlusion.\"},{\"question\":\"How was the thrombectomy performed and what was the outcome?\",\"answer\":\"An 8-Fr system was advanced from the right femoral artery, and thrombectomy was performed using Solitaire X 3×20 mm without rt-PA given the uncertain onset time. Recanalization was achieved, and the patient was transferred with a modified Rankin Scale score of 1.\"}]","Mechanical Thrombectomy for Medium-Vessel Occlusion with a Right-Sided Aortic Arch - A Case Report | PDF",1790417568,15]