bhargavi
Guru
71-year-old male who recently had a transient ischemic attack diagnosed with bilateral severe carotid stenosis. It was thought that the culprit lesion was a left internal carotid artery due to the laterality of the disease. 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 11:09 AM and monitoring period Ended 12:09 PM. 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 left femoral artery. A 5 French pigtail catheter was used to perform the arch angiogram. A 5 French VTK catheter was used to selectively engage the left subclavian artery and the left carotid artery
Finding:
1: The arch angiogram showed a type II aortic arch
2: Patent left subclavian artery and the patent left vertebral artery
3: Left common carotid artery is relatively free of disease. There is severe stenosis at the origin of the left internal as well as the left external carotid arteries. This is a heavy disease calcific plaque. The intracerebral angiogram showed absence of the middle cerebral artery. There is crossover left to right.
Impression: Severe stenosis in the origin of the left internal carotid artery.
thank you in advance
I am thinking 36224?
Finding:
1: The arch angiogram showed a type II aortic arch
2: Patent left subclavian artery and the patent left vertebral artery
3: Left common carotid artery is relatively free of disease. There is severe stenosis at the origin of the left internal as well as the left external carotid arteries. This is a heavy disease calcific plaque. The intracerebral angiogram showed absence of the middle cerebral artery. There is crossover left to right.
Impression: Severe stenosis in the origin of the left internal carotid artery.
thank you in advance
I am thinking 36224?