need help with failed attempt pci

bhargavi

Guru
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105
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0
Hemodynamics:

The aortic pressure was 82/52 mmHg.

Coronary Angiography:

Right coronary artery is a large-caliber codominant vessel with 100% proximal occlusion.

Left Main coronary artery is of large caliber and appears to be patent.

Left anterior descending is a large caliber vessel with patent proximal segment, patent mid segment, patent distal segment with luminal irregularities.  Apical LAD is a small caliber vessel.  There are 2 small diagonal branches with luminal irregularities.

Left circumflex is a large-caliber codominant vessel which appears to be patent throughout its course.  Obtuse marginal 1 is a large caliber vessel luminal irregularities.  Obtuse marginal 2 is a medium caliber vessel luminal irregularities.  Obtuse marginal 3 is a medium to large caliber vessel luminal irregularities.  LPL is a medium caliber vessel luminal irregularities.

The patient was then transferred to the recovery area in stable condition:

Summary conclusion:

1. High grade lesion in proximal RCA.
2.  Abnormal CTA
3.  Hypertension
4.  GERD
5.  Dyspnea on exertion

Recommendation:

Recommend PCI of proximal RCA.

6 French IMA guide was used to engage right coronary artery.  Patient was anticoagulated using 90 units/kg heparin.  I was about to advance run-through wire and asked for fluoroscopic angiography which revealed prominent flow into the mid and distal segment of RCA.  Subsequent angiography revealed TIMI-3 flow throughout the RCA.  At this time procedure was aborted and TR band was placed on right radial artery access site.  Possible explanation for the above findings could be coronary vasospasm versus thrombus.

thanks in advance

should I only do 93454 or 92920-rc,74? I bill for hospital




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zoinks071

Contributor
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22
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Syracuse, NY
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I would recommend sticking with just the angiography only, 93454. In my reading of the note it doesn't really state that the angioplasty was attempted and then discontinued. Subsequent angio of the RCA showed TIMI 3 flow so the MD never crossed a lesion or deployed a balloon catheter. I hope that helps! :)
 
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