A vertical alpha (α) and u loop of cervical subclavian artery in an octagenerian

We present an interesting and unusual vertical alpha loop (α-loop) of the subclavian artery in the neck with simultaneous presence of proximal U-loop during transradial coronary angiogram in an octogenarian presenting with Non-ST elevation myocardial infarction (NSTEMI) with ongoing angina. Tortuosity prevails during transradial coronary angiogram in octogenarians but presence of such an alpha loop (α-Loop) in the subclavian artery pushing the subclavian artery in to the neck (cervical subclavian artery) has not been described so far in the literature. Although the loop could be crossed with a terumo wire and a tiger catheter, transradial coronary angiogram could not be accomplished due to presence of extreme tortuosity in the form of alpha loop (α-loop) in the cervical subclavian artery even with the use of extra stiff wire, guide catheter and parallel wire technique1. Transaradial coronary angiogram was accomplished from left transradial access. Young interventionists should keep the possibility of such an extreme tortuosity in the form of alpha loop (α-loop) in subclavian artery which will preclude conventional right transradial coronary angiogram and would render for an alternative vascular access to accomplish coronary angiography.