bhargavi
Guru
Procedures performed:
Description of procedure: patient was brought to angio suite and identified using multiple patient identifiers. Time out was performed by entire team. Patient was placed in supine position on angiography table and bilateral ground and right wrist was cleaned using beta fine solution. Sterile drape was applied. Right radial artery using ultrasound was palpated and under ultrasound 5 French sheath was placed using micro puncture kit and modified Seldinger technique. This was sutured and continuously flushed with pressurized heroism saline. A 5 French angled glide catheter was continuously flushed with heparinized swine and was then navigated over 0.035 guidewire up to arch of sorts where it was reconstituted and following blood vessels were catheterized- Right common, right internal, left common, left internal, right subclavian, right vertebral artery. The angiogram was analyzed and subsequently removed from the body without any incident. Patient was examined without any neurological deficits and femoral sheath was removed and angioseal was deployed Complications - None during the procedure. Postprocedure after 60 to 80 minutes patient blood pressure was very elevated more than 200s and she end up having hypertensive emergency with encephalopathy. Considering patient old strokes and her complicated medical history and unable to control her blood pressure since patient is noncompliance with the medications and was not taking her medications at home it was decided to admit the patient and have strict control of blood pressure in order to avoid any major strokes. Disposition- Patient sent back to ambulatory surgery care for further monitoring Interpretation : Right common carotid artery angiogram: Right common carotid artery angiogram demonstrates normal appearing common carotid artery. Right common carotid artery bifurcates at c3-c4 cervical vertebrae. The bifurcation of Right common carotid artery appears normal. It bifurcates into Right internal carotid artery and Right External carotid artery. Origin of Right internal carotid artery shows around 30% stenosis as per NASCET criteria, the external carotid artery appears normal with normal appearing branches of right external carotid artery.The capillary, tissue and venous phase of above mentioned arteries appears normal. Right Internal carotid artery angiogram, neck and head - Right internal carotid artery demonstrates normal appearing cervical segment of right internal carotid artery beyond the bifurcation.The cervical segment continues into right petrous segment and cavernous segment of right internal carotid artery. The petrous and cavernous segment appears normal with no major hemodynamic stenosis. The cavernous segment continues into ophthalmic segment. The ophthalmic artery appears normal in shape and caliber. The terminus portion of right internal carotid artery bifurcates into right middle cerebral artery and right anterior cerebral artery. The right middle cerebral M1 segment appears normal proximally but distally there appears to be around 30% narrowing and the superior and inferior segment also appears normal but no major stenosis or other abnormality seen. The terminal segment of middle cerebral arteries appears normal. The Anterior cerebral artery A1 segment and A2 segment also appear normal. On lateral view of angiogram pericallosal dn callosomarginal arteries can be seen. The capillary, tissues and venous phase of all the above arteries appears normal. Left common carotid artery angiogram: Left common carotid artery angiogram demonstrates normal appearing common carotid artery. Left common carotid artery bifurcates at c3 cervical vertebrae. The bifurcation of Left common carotid artery shows around 73% stenosis at the origin of left internal carotid artery from severe atherosclerotic plaque. The external carotid artery appears normal with normal appearing branches of right external carotid artery.The capillary, tissue and venous phase of above mentioned arteries appears normal. Left Internal carotid artery angiogram, neck and head - Left internal carotid artery demonstrates normal appearing cervical segment of internal carotid artery.The cervical segment continues into petrous segment and cavernous segment of left internal carotid artery. The petrous and cavernous segment appears normal with no major hemodynamic stenosis. The cavernous segment continues into ophthalmic segment. The ophthalmic artery appears normal in shape and caliber. The terminus portion of left internal carotid artery bifurcates into right middle cerebral artery and right anterior cerebral artery. The right middle cerebral M1 segment appears normal along with normal-appearing tertiary branches of middle cerebral artery also on the anterior cerebral artery appears normal with normal-appearing pericallosal callosomarginal arteries. Right subclavian artery angiogram - Angiogram from proximal Subclavian artery demonstrates normal appearing subclavian artery with no stenosis. The vertebral artery origin appears normal along with other branches of subclavian like Thyrocervical, internal thoracic artery,Transverese cervical and suprascapular artery. Right vertebral artery angiogram- Right vertebral artery angiogram demonstrates normal appearing angiogram of right vertebral artery. The V1 and V2 segment appears normal. The vertebral artery VB junction appears normal with normal appearing PICA (posterior inferior cerebellar artery)on right. Basilar artery appears normal with normal appearing bilateral AICA. The basilar artery ends in bilateral PCA. The capillary, tissue and venous phase all appears normal. Impression: 1. Angiogram demonstrated around 73% stenosis as per NASCET criteria of the left internal carotid artery at the origin with severe atherosclerotic plaque. 2. The right internal carotid artery demonstrated on 30% stenosis as per NASCET criteria at the region of right internal carotid artery 3. Normal-appearing stereo circulation. thanks in advance should I do 36224-50, 36226-RT? thanks for previous carotid case help |
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