calorom2
Networker
Is anyone able to give me some guidance on this?
33990, 92933-LC? Thanks in advance!
PROCEDURES PERFORMED:
1. Distal aortogram, right and left iliac and common femoral angiogram.
2. Impella CP insertion. Insertion of external heart assist system
into heart, percutaneous approach.
3. Assistance with cardiac output using Impella pump, continuous.
4. CSI rotablation, proximal circumflex.
5. PTCA, proximal and mid circumflex.
6. Drug-eluting stent Resolute integrity 3.0/34 mm proximal to mid
circumflex artery.
7. Perclose arteriotomy closure of the 14-French Impella insertion site.
8. Vascular ultrasound guidance to access right common femoral artery
and left common femoral artery.
COMPLICATIONS:
None.
DESCRIPTION OF PROCEDURE:
Procedure is a high-risk procedure. Surgical backup was obtained from
Dr. M.
The risks and benefits of high-risk PCI were discussed with the patient.
Alternatives include coronary artery bypass surgery. The patient is
reluctant to undergo bypass surgery if not needed.
Time-out was performed. The patient, physician, and procedure to be
performed were identified.
The patient was prepped and draped in the normal fashion.
Using ultrasound guidance, the left common femoral artery was accessed
and a 6-French sheath was introduced without difficulty. Distal aortogram
was performed using a 6-French pigtail. Distal aortogram showed no
abdominal aortic aneurysm. The left common iliac and external iliac
artery appeared to be tortuous. The right common iliac and external
iliac showed less tortuosity and was a preferable artery for Impella
insertion.
Ultrasound guidance was used to gain access into the right common femoral
artery. Access was obtained without difficulty. Perclose sutures were
made in a X fashion x2. The tract was dilated with multiple dilatation
catheters. Finally, a 14-French long sheath was inserted without difficulty.
The left ventricle was accessed using a JR4 and a J-wire. The J-wire
was exchanged for a 0.025 guidance wire. The Impella was inserted into
the left ventricle without difficulty. The Impeller was activated and
very good output was obtained.
Our attention was directed to the left groin sheath. The sheath was
upgraded to a 7-French sheath. A 7-French 3.5 EBU guide catheter was
used to engage the left main. A run-through wire was advanced through
the proximal heavy calcified stenosis and placed in the distal circumflex
artery. This wire was exchanged for a ViperWire. ACI 1.25 burr was
advanced into the left main. Multiple runs were made through the calcific
stenotic lesions. Multiple runs were made to the mid level. The Rotablator
was dilated with a 2.75/20 mm balloon. A GuideLiner was used to insert
the drug-eluting stent Resolute integrity 3.0/34 mm from the ostial/proximal
segment to the mid segment. This stent was deployed to nominal atmospheres.
The stent was post dilated with a 3.0/20 mm noncompliant balloon to
14 atmospheres throughout the length. We were not able to pass a Dragonfly
OCT catheter beyond the proximal segment.
Final angiography showed the previous 90% stenosis to have 0% stenosis.
The Impella was weaned and was discontinued without hemodynamic depression.
The sheath was removed and the Perclose sutures were tightened. Good
hemostasis was obtained. The left 7-French sheath was withdrawn and
an 8-French Angio-Seal collagen sponge was successfully deployed. Good
hemostasis was obtained.
The patient tolerated the procedure well and was transferred to the recovery
area in stable condition.
33990, 92933-LC? Thanks in advance!
PROCEDURES PERFORMED:
1. Distal aortogram, right and left iliac and common femoral angiogram.
2. Impella CP insertion. Insertion of external heart assist system
into heart, percutaneous approach.
3. Assistance with cardiac output using Impella pump, continuous.
4. CSI rotablation, proximal circumflex.
5. PTCA, proximal and mid circumflex.
6. Drug-eluting stent Resolute integrity 3.0/34 mm proximal to mid
circumflex artery.
7. Perclose arteriotomy closure of the 14-French Impella insertion site.
8. Vascular ultrasound guidance to access right common femoral artery
and left common femoral artery.
COMPLICATIONS:
None.
DESCRIPTION OF PROCEDURE:
Procedure is a high-risk procedure. Surgical backup was obtained from
Dr. M.
The risks and benefits of high-risk PCI were discussed with the patient.
Alternatives include coronary artery bypass surgery. The patient is
reluctant to undergo bypass surgery if not needed.
Time-out was performed. The patient, physician, and procedure to be
performed were identified.
The patient was prepped and draped in the normal fashion.
Using ultrasound guidance, the left common femoral artery was accessed
and a 6-French sheath was introduced without difficulty. Distal aortogram
was performed using a 6-French pigtail. Distal aortogram showed no
abdominal aortic aneurysm. The left common iliac and external iliac
artery appeared to be tortuous. The right common iliac and external
iliac showed less tortuosity and was a preferable artery for Impella
insertion.
Ultrasound guidance was used to gain access into the right common femoral
artery. Access was obtained without difficulty. Perclose sutures were
made in a X fashion x2. The tract was dilated with multiple dilatation
catheters. Finally, a 14-French long sheath was inserted without difficulty.
The left ventricle was accessed using a JR4 and a J-wire. The J-wire
was exchanged for a 0.025 guidance wire. The Impella was inserted into
the left ventricle without difficulty. The Impeller was activated and
very good output was obtained.
Our attention was directed to the left groin sheath. The sheath was
upgraded to a 7-French sheath. A 7-French 3.5 EBU guide catheter was
used to engage the left main. A run-through wire was advanced through
the proximal heavy calcified stenosis and placed in the distal circumflex
artery. This wire was exchanged for a ViperWire. ACI 1.25 burr was
advanced into the left main. Multiple runs were made through the calcific
stenotic lesions. Multiple runs were made to the mid level. The Rotablator
was dilated with a 2.75/20 mm balloon. A GuideLiner was used to insert
the drug-eluting stent Resolute integrity 3.0/34 mm from the ostial/proximal
segment to the mid segment. This stent was deployed to nominal atmospheres.
The stent was post dilated with a 3.0/20 mm noncompliant balloon to
14 atmospheres throughout the length. We were not able to pass a Dragonfly
OCT catheter beyond the proximal segment.
Final angiography showed the previous 90% stenosis to have 0% stenosis.
The Impella was weaned and was discontinued without hemodynamic depression.
The sheath was removed and the Perclose sutures were tightened. Good
hemostasis was obtained. The left 7-French sheath was withdrawn and
an 8-French Angio-Seal collagen sponge was successfully deployed. Good
hemostasis was obtained.
The patient tolerated the procedure well and was transferred to the recovery
area in stable condition.