61635 and 61630
PROCEDURE: FSP NEURO INTERVENTION PROCEDURE
INDICATION: STROKE
TECHNIQUE: The right groin was prepped and draped in a sterile
fashion. Versed and Fentanyl were given for sedation. The groin was
anesthesized with 1% lidocaine, and eleven blade used to incise the
skin. Single wall puncture was used to access the right common femoral
artery. A wire was advanced, and a 4 French sheath placed, and
connected to heparinized saline. Then, a 4 French VER was advanced.
The right vertebral artery was selected, and angiogram performed.
Catheter was pulled back, and selection of the right common carotid
artery perfomed with cervical angiography performed. Then the catheter
was advanced into the right internal carotid artery, and intracranial
cerebral angiogram performed.
Next, the catheter was pulled back, and selection of the left common
carotid artery perfomed with cervical angiography performed. Then the
catheter was advanced into the left internal carotid artery, and
intracranial cerebral angiogram performed.
Catheter exchange for a 6-French guiding catheter in the left ICA. This
was connected to pressurized heparinized saline. Then, a 3 mm balloon
was advanced. Angioplasty was performed within the left carotid
communicating segment. Balloon was removed, and wire withdrawn. Repeat
angiography was performed.
Catheter was then removed. The sheath was removed and hemostasis
achieved with manual pressure. The patient suffered no immediate
complication and returned to the floor in stable condition.
FINDINGS:
The right vertebral origin is tortuous. The visualized portions of the
posterior circulation are normal, although study is limited here due to
tortuosity. Stenosis seen on MRA in the basilar is not well
appreciated on this exam, but appears less than 50%.
The cervical carotids are normal, with 0% stenosis based on NASCET
criteria.
On the right, there is atherosclerotic change noted within the M1
segment, but less than 50% stenosis is present here. Multifocal areas
of stenosis are noted within the anterior cerebral arteries, with focal
narrowing of the left pericallosal artery at least 60%. The left A1
segment has critical stenosis greater than 90%, with majority of the
supply to the anterior cerebral arteries via the right.
On the left, there is focal 90% stenosis of the ICA just within the
proximal communicating segment. Post angioplasty, there is less than
30% narrowing. Brisk flow is noted within the left ICA post procedure.
There is marked improvement in distal perfusion post procedure. Small
distal M2 occlusion appears chronic, likely sequela of recent stroke.
IMPRESSION:
1. Severe atherosclerotic changes within the left pericallosal, left
ACA, and the left carotid. Communicating segment ICA stenosis is
greater than 90%. Post angioplasty. This is less than 30%. Perfusion
is markedly improved in the left hemisphere post procedure.
2. Atherosclerotic changes in the right ICA and MCA are less than 50%
without significant stenosis identified.
This is my report, medicare EOB states required modifier is missing.
