amrcpc
Contributor
Please assist with cath placements and thrombectomy codes
I coded 37184(left P1 segment) ,36226 (left vert),36218 (P2 segment no angiogram performed),37185 (distal basilar artery)
report:
CLINICAL HISTORY:
Patient is a 56 yo man,referred for cerebral angiography and possible mechanical thrombectomy of the basilar artery thrombus identified on CT angiogram today. Patient was comatose and had a seizure following a fall from 10 feet
with multisystem trauma.
CLINICAL INDICATION:
To better delineate the anatomy in a high resolution study, in order to optimize medical decision making and management. An attempt to improve the patient's neurologic status by treating his stroke with thrombectomy.
PROCEDURE COMMENT:
Informed consent was obtained from the patient's sister prior to the examination.
Sedation: None
The right groin was prepared using a sterile technique and a right common femoral artery puncture was done to gain access using a 7F sheath. Through this sheath a 6-French Benchmark guiding catheter was advanced over a wire and used to perform selective
angiography of the left vertebral artery. This demonstrated that the patient had a filling defect consistent with thrombus in the basilar apex extending into both P1 segments with no significant antegrade flow into the superior cerebellar or posterior
cerebral arteries on either side. There is minimal outline of a clot in the left P1 noted. There is reflux down the right vertebral artery to the proximal cervical segment. The right AICA is duplicated and the left AICA and bilateral small PICA's fill
with contrast.
It was elected to perform thrombectomy. A Velocity microcatheter was advanced over a wire into the basilar apex. The right P1 could not be selected. The velocity was advanced to the P2 segment on the left. A Trevo stent was deployed extending from
the left P1 into the distal third of the basilar artery. This was left in place for 4 minutes prior to withdrawal. Follow-up angiography demonstrated that there was restoration of flow into the basilar apex with removal of thrombus from the left P1 and
basilar tip. There is flow into both superior cerebellar artery territories with slower flow on the right. The left PCA fills antegrade with contrast, although the P3 branches appear small. The right P1 and proximal P2 fill to the point where there
appears to be a thrombus, and this is the location of the occlusion on CTA. There was good leptomeningeal collateral flow to the distal PCA territory on the CT angiogram, so this clot was not pursued further. The basilar apex had no residual thrombus
seen. The procedure was terminated at this point. Patient began to spontaneously move his face and both right arm and leg immediately after restoration of flow to the basilar apex. There were no complications noted.
Hemostasis was obtained in the right groin using the Perclose device.
The total contrast dose for the procedure was: 90 cc of Visipaque 320 .
The total radiation dose was approximately: 9294 cGycm2.
Thank you in advance
I coded 37184(left P1 segment) ,36226 (left vert),36218 (P2 segment no angiogram performed),37185 (distal basilar artery)
report:
CLINICAL HISTORY:
Patient is a 56 yo man,referred for cerebral angiography and possible mechanical thrombectomy of the basilar artery thrombus identified on CT angiogram today. Patient was comatose and had a seizure following a fall from 10 feet
with multisystem trauma.
CLINICAL INDICATION:
To better delineate the anatomy in a high resolution study, in order to optimize medical decision making and management. An attempt to improve the patient's neurologic status by treating his stroke with thrombectomy.
PROCEDURE COMMENT:
Informed consent was obtained from the patient's sister prior to the examination.
Sedation: None
The right groin was prepared using a sterile technique and a right common femoral artery puncture was done to gain access using a 7F sheath. Through this sheath a 6-French Benchmark guiding catheter was advanced over a wire and used to perform selective
angiography of the left vertebral artery. This demonstrated that the patient had a filling defect consistent with thrombus in the basilar apex extending into both P1 segments with no significant antegrade flow into the superior cerebellar or posterior
cerebral arteries on either side. There is minimal outline of a clot in the left P1 noted. There is reflux down the right vertebral artery to the proximal cervical segment. The right AICA is duplicated and the left AICA and bilateral small PICA's fill
with contrast.
It was elected to perform thrombectomy. A Velocity microcatheter was advanced over a wire into the basilar apex. The right P1 could not be selected. The velocity was advanced to the P2 segment on the left. A Trevo stent was deployed extending from
the left P1 into the distal third of the basilar artery. This was left in place for 4 minutes prior to withdrawal. Follow-up angiography demonstrated that there was restoration of flow into the basilar apex with removal of thrombus from the left P1 and
basilar tip. There is flow into both superior cerebellar artery territories with slower flow on the right. The left PCA fills antegrade with contrast, although the P3 branches appear small. The right P1 and proximal P2 fill to the point where there
appears to be a thrombus, and this is the location of the occlusion on CTA. There was good leptomeningeal collateral flow to the distal PCA territory on the CT angiogram, so this clot was not pursued further. The basilar apex had no residual thrombus
seen. The procedure was terminated at this point. Patient began to spontaneously move his face and both right arm and leg immediately after restoration of flow to the basilar apex. There were no complications noted.
Hemostasis was obtained in the right groin using the Perclose device.
The total contrast dose for the procedure was: 90 cc of Visipaque 320 .
The total radiation dose was approximately: 9294 cGycm2.
Thank you in advance