Bilateral Carotid Arteriogram


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Procedure Performed:
1. Thoracic aortic arch aortogram.
2. Bilateral selective carotid arteriogram.
3. Intracranial angiography.

Indication: Mr. Salmon presented with symptoms of dizziness without
known coronary artery disease with history of stents and noninvasive
imaging revealed high-grade stenosis of the left carotid artery with
CT angiography. However the degree of stenosis was not certain on
the CT angiography.

Protocol: The patient was brought to the cath laboratory. Right
groin was prepped and draped in the usual sterile fashion.
Xylocaine was infiltrated. A 5-French sheath was inserted without
difficulty and subsequently a 5-French pigtail catheter was advanced
and positioned in the ascending aorta. Thoracic aortogram was
performed subsequent to which the catheter is removed and then a
Headhunter catheter was advanced. The right brachiocephalic artery
was cannulated however the catheter was selected into the
brachiocephalic artery but could not be advanced into the right
carotid artery. The left carotid artery was cannulated selectively.
In both locations carotid as well as intracranial angiography was
performed. Total contrast used was 160 mL. No complications
occurred. The sheath was removed after the procedure was completed.

Findings: The aortogram revealed presence of normal-appearing
ascending arch and descending aorta with normal takeoff of the great
vessels. This appears to be a type 1 arch and the Headhunter
catheter was placed selectively in the right brachiocephalic artery.
The origin of the artery appears to be normal. The takeoff of the
carotid artery, common carotid artery, and the bulb area all
appeared to be normal. There is only mild, less than 20% plaque
noted and the external carotid artery is intact. The extracranial
portion of the carotid artery appears to be normal as well.

The right-sided intracranial circulation has less than optimal
visualization however appears to be intact with no definite lesions
identified. However there was some motion artifact as well as
suboptimal filling of the vessel and therefore may result in
accurately compromised.

The left carotid artery appears to show normal common carotid
artery, and the takeoff is preserved. The external carotid artery
is without any significant disease.

Internal carotid artery on the left side demonstrates an apple-core
lesion which appears to be at least 70 to 80% in severity. The
distal portion of the internal carotid artery as well as the
extracranial course appears to be without any significant disease.

The left intracranial angiography is selective and with good
excellent images and appears to have normal-appearing vessels
throughout the middle and anterior cerebral arteries with normal
venous phase.


1. The left internal carotid artery with 70 to 80% stenosis.
2. The right intracranial visualization was suboptimal.
3. Mild plaque on the right internal carotid artery.


True Blue
Alexandria, LA
Best answers
36215 (right brachiocephalic catheterization)
36215-59 (left common carotid catheterization
75650 - arch
75671 - bilateral cerebral carotid angiography
75680 - bilateral cervical carotid angiography