PMC8769408_01
Twelve-lead electrocardiogram. (a) Standard position electrocardiogram showed arterial fibrillation, right bundle branch block. Lead I demonstrates a largely negative QRS complex and inverted T waves. The QRS complexes in leads aVR and aVL are reversed. There is a loss of amplitude in the precordial leads toward V6. (b) Mirror image position electrocardiogram. Chest electrodes were placed in a mirror image position on the right side of the chest. Left and right limb leads were reversed.
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The QRS complexes in leads aVR and aVL were reversed. There was a loss of amplitude in the precordial leads toward V6 (Fig. 1a). Mirror image position electrocardiogram, which left and right limb leads were reversed and chest electrodes were placed in a mirror image position on the right side of the chest, showed usual electrocardiogram with arterial fibrillation and right bundle branch block (Fig. 1b).
Catheter navigation, thrombectomy, and CT angiography. (a) Balloon guiding catheter navigation on anteroposterior images. (b and c) Anteroposterior internal carotid artery injection (b) before and (c) after the thrombectomy. Final injection shows TICI 2B recanalization. (d and e) CT angiography on the day after procedure shows right-sided arch with mirror-image branching pattern. Innominate artery is on the left side and left common carotid artery arises from left innominate artery. Right vertebral artery directly arises from aortic arch. CT: computed tomography, LCCA: left common carotid artery, LIA: left innominate artery, LSCA: left subclavian artery, RCCA: right common carotid artery, RSCA: right subclavian artery, RVA: right vertebral artery, TICI: thrombolysis in cerebral infarction.
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Aichi, Japan) were advanced. Abdominal aorta was on the mid of spine, however guide catheter advanced through thoracic aorta to the right side of spine (Fig. 2a). Left internal carotid artery injection showed left M1 occlusion (Fig. 2b). TREVO devices (Stryker), thrombolysis in cerebral infarction (TICI) 2B recanalization was achieved after three passes (Fig. 2c). CT angiography showed right-sided aortic arch with mirror-image branching pattern (Fig. 2d and 2e).
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