Transoesophageal echocardiography can visualise and evaluate aberrant right subclavian artery stenosis and...

The utility of transoesophageal echocardiography for evaluating stenosis at the origin of the aberrant right subclavian artery has not been previously reported.

An 81-year-old male with recurrent cerebral infarctions associated with stenosis at the aberrant right subclavian artery origin underwent endovascular stenting. For pre-procedural assessment, transoesophageal echocardiography clearly demonstrated an isoechoic to hyperechoic plaque with calcification and a minimal luminal diameter-features that are difficult to assess using computed tomography. Identification of the aberrant right subclavian artery origin required understanding of the surrounding anatomy based on computed tomography imaging, as the lesion was located independently from the left subclavian artery, necessitating technical adjustments during scanning.

In heavily calcified vessels, computed tomography is limited in its ability to accurately assess stenosis severity because of artefacts caused by calcification, and it cannot characterise plaque morphology. In addition, post-stenting lumen evaluation is often hindered by metal artefacts. In contrast, transoesophageal echocardiography offers real-time imaging, detailed visualisation of plaque characteristics, and reliable confirmation of stent expansion, providing a useful alternative for evaluating and managing aberrant right subclavian artery stenosis. Conclusion: Transoesophageal echocardiography enables precise pre-procedural assessment and post-stenting evaluation.