em2177
Expert
93458,92980RC,93571??? IS THIS CORRECT? THANKS!!!
PREOPERATIVE DIAGNOSIS: Angina.
POSTOPERATIVE DIAGNOSIS: Multi-vessel coronary disease, stenting of the
circumflex coronary artery.
PROCEDURE(S) PERFORMED:
1. Left heart catheterization, coronary angiography.
2. Percutaneous coronary intervention with stenting of the 90% circumflex
lesion.
3. Fractional flow reserve (FFR) of the right coronary lesion.
PROCEDURE: The patient was prepped and draped in the usual fashion and brought
to the catheterization laboratory having been premedicated with Xanax and
Benadryl. Using 2% local Xylocaine, the right femoral region was anesthetized
using a single-wall technique. The right femoral artery was entered. An
introducer sheath was placed, through which a 4 left Judkins was advanced to
the ostium of the left coronary artery. Several hand injections visualized the
artery in various projections. This catheter was removed and replaced with a
Williams right catheter which was advanced to the ostium of the right coronary
artery. Several hand injections visualized the artery in various projections.
At this juncture, attention was turned toward intervention of a high-grade
lesion in the main circumflex artery which has an obtuse marginal orientation.
An 0.014 S'port wire was prepared and a 2.0 balloon. Angiomax was
administered. Wire was advanced down the artery, across the lesion, and into
the distal vessel and the balloon over the wire to the point of the lesion and
inflated and then removed and replaced with a 2.75 x 16 Promus stent. This was
fully expanded up to 14 atmospheres. Then the balloon was removed and a 3.0 x
8 balloon was brought to the middle of the stent and fully inflated to 14
atmospheres.
Angiograms post showed a markedly improved artery. Because she was
hypertensive she was given 5 mg of IV Lopressor times 2. She was also given
intracoronary nitroglycerin on a number of occasions.
At this juncture, attention was turned toward measuring the FFR across the
50-60% lesion in the right coronary artery. The pressure wire was advanced to
the point of the mandrel being out. The stent was zeroed and then the wire was
advanced distal to the lesion. Initially 40 meg of adenosine were given.
Measurement of FFR was 0.92. This was repeated with 80 meg of IV adenosine,
and again the FFR was 0.92, thus concluding this was not physiologically
producing ischemia.
The patient was placed on IV nitroglycerin. She still had somewhat elevated
blood pressure. The sheath was removed and hemostasis was achieved with
Angio-Seal. The patient tolerated the procedure well and there were no
complications.
ANGIOGRAPHIC DATA:
1. The left main is short. The LAD is widely patent and there is a widely
patent stent. No significant stenosis. The main portion of the circumflex
has a proximal 90% lesion, after which there is a gap with a normal segment,
and then there is a previously placed stent which is fully expanded and
fully patent artery. The right coronary artery shows some ostial and
proximal 40% lesion. There are multiple stents placed in the right from the
proximal to the distal portion. In the middle of this there is an
approximately 50% in-stent restenosis.
2. Successful stenting of the 90% circumflex lesion with a 2.75 Promus stent,
16, post dilated with a 3.0.
3. FFR of the right coronary lesion with values of 0.92 with both 40 and 80
meg of IV adenosine.
PREOPERATIVE DIAGNOSIS: Angina.
POSTOPERATIVE DIAGNOSIS: Multi-vessel coronary disease, stenting of the
circumflex coronary artery.
PROCEDURE(S) PERFORMED:
1. Left heart catheterization, coronary angiography.
2. Percutaneous coronary intervention with stenting of the 90% circumflex
lesion.
3. Fractional flow reserve (FFR) of the right coronary lesion.
PROCEDURE: The patient was prepped and draped in the usual fashion and brought
to the catheterization laboratory having been premedicated with Xanax and
Benadryl. Using 2% local Xylocaine, the right femoral region was anesthetized
using a single-wall technique. The right femoral artery was entered. An
introducer sheath was placed, through which a 4 left Judkins was advanced to
the ostium of the left coronary artery. Several hand injections visualized the
artery in various projections. This catheter was removed and replaced with a
Williams right catheter which was advanced to the ostium of the right coronary
artery. Several hand injections visualized the artery in various projections.
At this juncture, attention was turned toward intervention of a high-grade
lesion in the main circumflex artery which has an obtuse marginal orientation.
An 0.014 S'port wire was prepared and a 2.0 balloon. Angiomax was
administered. Wire was advanced down the artery, across the lesion, and into
the distal vessel and the balloon over the wire to the point of the lesion and
inflated and then removed and replaced with a 2.75 x 16 Promus stent. This was
fully expanded up to 14 atmospheres. Then the balloon was removed and a 3.0 x
8 balloon was brought to the middle of the stent and fully inflated to 14
atmospheres.
Angiograms post showed a markedly improved artery. Because she was
hypertensive she was given 5 mg of IV Lopressor times 2. She was also given
intracoronary nitroglycerin on a number of occasions.
At this juncture, attention was turned toward measuring the FFR across the
50-60% lesion in the right coronary artery. The pressure wire was advanced to
the point of the mandrel being out. The stent was zeroed and then the wire was
advanced distal to the lesion. Initially 40 meg of adenosine were given.
Measurement of FFR was 0.92. This was repeated with 80 meg of IV adenosine,
and again the FFR was 0.92, thus concluding this was not physiologically
producing ischemia.
The patient was placed on IV nitroglycerin. She still had somewhat elevated
blood pressure. The sheath was removed and hemostasis was achieved with
Angio-Seal. The patient tolerated the procedure well and there were no
complications.
ANGIOGRAPHIC DATA:
1. The left main is short. The LAD is widely patent and there is a widely
patent stent. No significant stenosis. The main portion of the circumflex
has a proximal 90% lesion, after which there is a gap with a normal segment,
and then there is a previously placed stent which is fully expanded and
fully patent artery. The right coronary artery shows some ostial and
proximal 40% lesion. There are multiple stents placed in the right from the
proximal to the distal portion. In the middle of this there is an
approximately 50% in-stent restenosis.
2. Successful stenting of the 90% circumflex lesion with a 2.75 Promus stent,
16, post dilated with a 3.0.
3. FFR of the right coronary lesion with values of 0.92 with both 40 and 80
meg of IV adenosine.
