Wiki need help with carotid angio

bhargavi

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Conclusion



55-year-old male with severe peripheral vascular disease and coronary artery disease was diagnosed with severe left carotid stenosis referred for carotid angiogram prior to stenting.  10:37 AM procedure, risks, benefits, alternative options were explained. Risks including bleeding, infection, cerebrovascular accident, myocardial infarction, death, and arrhythmia were all explained patient was agreeable. He was brought into the cardiac cath lab where conscious sedation (moderate sedation) was performed by myself using Versed and fentanyl. Conscious sedation was started 10:37 AM and monitoring period Ended 11:28 AM. I was present throughout this whole entire period With the patient.  Both groins were prepped and draped in the usual fashion. 2% lidocaine was used to anesthesize the skin. Using modified Seldinger technique, a 5 French sheath was inserted in the right femoral artery.  Arch angiogram was performed with a 5 French pigtail catheter.  Selective left subclavian angiogram as well as selective left carotid angiogram was performed with a 5 French VTK catheter.  The catheter was advanced into the distal common carotid.
Finding:
1: The arch angiogram showed a type II bovine aortic arch.
2: Left subclavian angiogram showed a patent vessel and a patent left vertebral artery
3: I was able to manipulate the catheter and selectively engage the left common carotid artery as this is a bovine arch.  A zip wire was advanced into the internal carotid artery over which the VTK catheter was advanced.  Selective angiogram was performed.  There is 80 to 85% stenosis in the distal common carotid artery involving the origin of both the internal and external carotid arteries.  Intracerebral circulation appears to be somewhat preserved.
Impression: Severe stenosis in the distal left common carotid artery involving the origin of the left internal carotid artery.  The patient had had previous significant complications with vascular bypass surgery.  The patient does have also untreatable coronary artery disease.

Plan: We will arrange for the patient for carotid stenting​
thanks in advance I am thinking 36223, 36225
 
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