Procedure 1
Indications
Conclusion
80% then 50% stenosis of the mid LCx, 90-95% distal LCx, 95% ostial OM 2 stenosis.
30% mid LAD stenosis.
70% mid RPDA stenosis.
INTERVENTION:
PCI of distal LCx into OM 2 stenosis with 2.5 x 12 mm DES
PCI of mid LCx stenosis with a 3.0 x 18 mm DES
PROCEDURES PERFORMED:
Coronary angiography
Aortic root angiogram
PCI of LCx and OM2
PROCEDURE:
The right wrist and and right groin were prepped and draped in a sterile manner.
The soft tissue above the right wrist was locally anesthetized with 1% lidocaine solution.
The right radial artery was accessed with a 20 gauge angiocatheter needle using the through-and-through technique and 6 Fr Glidesheath was placed.
Unable to engage the RCA with a JR4, ARmod, an aortic root angiography was performed with a Pigtail catheter. The RCA was engaged with an AL1 diagnostic catheter and selective angiography was performed in multiple views.
A 5 Fr JL3.5 diagnostic catheter which was used to perform selective angiography of the left coronary system in multiple views.
A 6Fr EBU 3.75 guide catheter was used to engage the LMCA. A Prowater wire was used to wire the LCx and into the OM2 branch. A 2.5 x 12 mm SC balloon was used to perform angiography of the 80% mid LCX and the distal LCx stenosis into the OM2 branch to 12 atm.
A Resolute Onyx 2.5 x 12 mm DES was deployed 12 atm to the distal LCx into ostial OM2 stenosis. Next, a Resolute Onyx 3.0 x 18 mm DES was deployed to the mid LCx stenosis.
At the end of the procedure, a equipment was removed and hemostasis was achieved with a radial band. A 3.0 x 18 mm NC balloon was used to post dilate the proximal stent to 16 atm.
At the end of the procedure, all wires and catheters were removed. A radial band was used to obtain hemostasis of the right radial artery.
FINDINGS:
LMCA - Arises from the left sinus of Valsalva, bifurcates into the LAD and LCX. Angiographically patent.
LAD - Arises from the LMCA, gives off 2 diagonal branches then wraps around the apex. There is a 30% mid LAD stenosis.
LCX - Arises from the LMCA, gives off 3 OM branches. Theres an 80% followed by 50% stenosis of the mid LCx, a 90-95% distal LCx, 95% ostial OM 2 stenosis.
RCA - Arises from the right sinus of Valsalva, gives off a small PDA and small PLB. Theres diffuse, mild, non-obstructive disease of the RCA and a 70% mid PDA stenosis.
Implants
PROCEDURE 2
Procedures
Indications
Conclusion
Acute in-stent thrombosis of the distal LCx into OM2 stent
INTERVENTION:
Thrombectomy and PCI with POBA of distal LCx into OM2
PROCEDURES PERFORMED:
CORONARY ANGIOGRAPHY
THROMBECTOMY OF DISTAL LCX INTO OM2.
PCI WITH POBA TO DISTAL LCX INTO OM2
PROCEDURE:
The left wrist and and right groin were prepped and draped in a sterile manner.
The soft tissue above the left wrist was locally anesthetized with 1% lidocaine solution.
The left radial artery was accessed with a 20 gauge angiocatheter needle using the through-and-through technique and 6 Fr Glidesheath was placed.
An AL1 diagnostic catheter was used to engage the RCA and performed selective angiography.
A JL4 diagnostic catheter which was used to perform selective angiography of the left coronary system in multiple views.
Unable to engage the LMCA with an EBU4, EBU3.75, JL4 guide from the left radial, access of the right common femoral artery was obtained under ultrasound guidance with a micropuncture needle under ultrasound guidance and a 6 Fr sheath was placed. An EBU 4.0 guide was used to engage the LMCA. A Prowater wire was used to cross the distal thrombosis. A 2.5 x 12 mm SC balloon was used to perform angioplasty to 12 atm. Aggrastat was started. An Export thrombectomy system was used to perform thrombectomy of the distal LCx/OM with 2 passes. Multiple doses of adenosine and nicardipine were administered until good flow was established and the patient was chest pain free.
At the end of the procedure, a equipment was removed and hemostasis of the left radial was achieved with a radial band. An angioseal device was used to obtain hemostasis of the right CFA.
FINDINGS:
LMCA - Arises from the left sinus of Valsalva, bifurcates into the LAD and LCX. Angiographically patent.
LAD - Arises from the LMCA, gives off
LCX - Arises from the LMCA, gives off
RCA - Arises from the right sinus of Valsalva, gives off a
Implants
| Coronary angiography | ||||
| Percutaneous coronary intervention | ||||
Pre Procedure Diagnosis
| Post Procedure Diagnosis
| |||
| NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC) [I21.4 (ICD-10-CM)] |
| Unstable angina pectoris (CMS/HCC) [I20.0 (ICD-10-CM)] |
80% then 50% stenosis of the mid LCx, 90-95% distal LCx, 95% ostial OM 2 stenosis.
30% mid LAD stenosis.
70% mid RPDA stenosis.
INTERVENTION:
PCI of distal LCx into OM 2 stenosis with 2.5 x 12 mm DES
PCI of mid LCx stenosis with a 3.0 x 18 mm DES
PROCEDURES PERFORMED:
Coronary angiography
Aortic root angiogram
PCI of LCx and OM2
PROCEDURE:
The right wrist and and right groin were prepped and draped in a sterile manner.
The soft tissue above the right wrist was locally anesthetized with 1% lidocaine solution.
The right radial artery was accessed with a 20 gauge angiocatheter needle using the through-and-through technique and 6 Fr Glidesheath was placed.
Unable to engage the RCA with a JR4, ARmod, an aortic root angiography was performed with a Pigtail catheter. The RCA was engaged with an AL1 diagnostic catheter and selective angiography was performed in multiple views.
A 5 Fr JL3.5 diagnostic catheter which was used to perform selective angiography of the left coronary system in multiple views.
A 6Fr EBU 3.75 guide catheter was used to engage the LMCA. A Prowater wire was used to wire the LCx and into the OM2 branch. A 2.5 x 12 mm SC balloon was used to perform angiography of the 80% mid LCX and the distal LCx stenosis into the OM2 branch to 12 atm.
A Resolute Onyx 2.5 x 12 mm DES was deployed 12 atm to the distal LCx into ostial OM2 stenosis. Next, a Resolute Onyx 3.0 x 18 mm DES was deployed to the mid LCx stenosis.
At the end of the procedure, a equipment was removed and hemostasis was achieved with a radial band. A 3.0 x 18 mm NC balloon was used to post dilate the proximal stent to 16 atm.
At the end of the procedure, all wires and catheters were removed. A radial band was used to obtain hemostasis of the right radial artery.
FINDINGS:
LMCA - Arises from the left sinus of Valsalva, bifurcates into the LAD and LCX. Angiographically patent.
LAD - Arises from the LMCA, gives off 2 diagonal branches then wraps around the apex. There is a 30% mid LAD stenosis.
LCX - Arises from the LMCA, gives off 3 OM branches. Theres an 80% followed by 50% stenosis of the mid LCx, a 90-95% distal LCx, 95% ostial OM 2 stenosis.
RCA - Arises from the right sinus of Valsalva, gives off a small PDA and small PLB. Theres diffuse, mild, non-obstructive disease of the RCA and a 70% mid PDA stenosis.
Implants
| Stent | ||||||||||||||||
| Stent Onyx Rx 2.50 X 22 Mm - Log442465 - Implanted
| ||||||||||||||||
| Stent Onyx Rx 3.00 X 18 Mm - Log442465 - Implanted
|
PROCEDURE 2
Procedures
| Coronary angiography | ||||
| Percutaneous coronary intervention | ||||
Pre Procedure Diagnosis
| Post Procedure Diagnosis
| |||
| Unstable angina pectoris (CMS/HCC) [I20.0 (ICD-10-CM)] |
| Coronary stent thrombosis, initial encounter [T82.867A (ICD-10-CM)] |
Acute in-stent thrombosis of the distal LCx into OM2 stent
INTERVENTION:
Thrombectomy and PCI with POBA of distal LCx into OM2
PROCEDURES PERFORMED:
CORONARY ANGIOGRAPHY
THROMBECTOMY OF DISTAL LCX INTO OM2.
PCI WITH POBA TO DISTAL LCX INTO OM2
PROCEDURE:
The left wrist and and right groin were prepped and draped in a sterile manner.
The soft tissue above the left wrist was locally anesthetized with 1% lidocaine solution.
The left radial artery was accessed with a 20 gauge angiocatheter needle using the through-and-through technique and 6 Fr Glidesheath was placed.
An AL1 diagnostic catheter was used to engage the RCA and performed selective angiography.
A JL4 diagnostic catheter which was used to perform selective angiography of the left coronary system in multiple views.
Unable to engage the LMCA with an EBU4, EBU3.75, JL4 guide from the left radial, access of the right common femoral artery was obtained under ultrasound guidance with a micropuncture needle under ultrasound guidance and a 6 Fr sheath was placed. An EBU 4.0 guide was used to engage the LMCA. A Prowater wire was used to cross the distal thrombosis. A 2.5 x 12 mm SC balloon was used to perform angioplasty to 12 atm. Aggrastat was started. An Export thrombectomy system was used to perform thrombectomy of the distal LCx/OM with 2 passes. Multiple doses of adenosine and nicardipine were administered until good flow was established and the patient was chest pain free.
At the end of the procedure, a equipment was removed and hemostasis of the left radial was achieved with a radial band. An angioseal device was used to obtain hemostasis of the right CFA.
FINDINGS:
LMCA - Arises from the left sinus of Valsalva, bifurcates into the LAD and LCX. Angiographically patent.
LAD - Arises from the LMCA, gives off
LCX - Arises from the LMCA, gives off
RCA - Arises from the right sinus of Valsalva, gives off a
Implants
| No implant documentation for this case. |