bhargavi
Guru
70-year-old male with history of carotid disease status post right carotid endarterectomy presented thing with recurrence of symptoms. Carotid ultrasound showed severe stenosis in the right carotid endarterectomy site and CTA confirmed severe stenosis. He was brought in for diagnostic angiogram. 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 9:59 AM and monitoring period Ended 10:47 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. A 5 French pigtail catheter and a 5 French VTK were used to perform the aortogram as well as the selective carotid angiogram. On the right side the VTK catheter was advanced to the right common carotid artery beyond the bifurcation of the innominate into the carotid and the right subclavian for selective angiogram. Finding: 1: The left subclavian angiogram is patent. The left vertebral artery is patent 2: Patent left common carotid artery. There is 20% stenosis in the origin of the left internal carotid artery. Intracerebral circulation is patent. There is significant crossover from left to right feeding the right anterior cerebral artery. There is only venous return on the right. There is no venous return in the left 3: Patent innominate artery and right subclavian artery. 4: There is severe stenosis at the area of previous carotid endarterectomy causing more than 90% stenosis. There is occlusion of the right anterior cerebral artery. This could be either due to occlusion or due to competitive flow 5: Arch angiogram showed a type II aortic arch 6: Abdominal aortogram showed patent bilateral common iliac artery stent. There is evidence of moderate disease of the edge of the left iliac stent Impression: Severe stenosis in the area of previous carotid endarterectomy of the right internal carotid artery with occlusion of the right anterior tibial artery with significant crossover from left to right Plan: We will bring the patient back for right internal carotid artery stenting |
thanks in advance
should I do 36224?