jlb102780
Guru
Hi Everyone,
I'm in need of some expert advise on this case below. Any help is appreciated.
INDICATION FOR TEST
Abnormal nuclear stress test.
PROCEDURES PERFORMED
1. Right radial access.
2. Selective catheter placement and imaging of the right brachial artery.
3. Selective catheter placement and imaging of the right axillary artery.
4. Selective catheter placement and imaging of the subclavian artery.
5. Selective catheter placement and imaging of the right innominate artery.
REPORT
The patient was brought to the cath lab and, due to 100% infrarenal aortic
occlusion, the decision was made to proceed via the right radial approach.
Allen test was negative. The right radial artery was cannulated using a
micropuncture technique, and a 4-French Microglide sheath was placed. The
wire, unfortunately, would not traverse past the axillary artery. At this
point, after administration of the radial cocktail, including verapamil,
nitroglycerin and heparin, the 4-French glide catheter was placed into that
space. Direct injection of the catheter revealed a patent brachial artery,
patent axillary artery with moderate disease. Upon continuation of wire
placement into the subclavian artery, there appeared to be significant
tortuosity and two S-type bends. At this point, the glide catheter was
placed selectively into the distal subclavian artery. At this point, it was
noted that there was a large plaque burden at the origin of the right common
carotid artery. In addition, after the common carotid artery, the innominate
artery does make a 90-degree bend retrograde. At this point, the catheter
would not traverse any further. Due to the significant nature and severe
tortuosity with additional plaque burden near the ostium of the carotid
artery, the catheter and all wire equipment was removed. In addition, the
patient was fairly non-cooperative during the procedure and managed to break her restraints and move her arm constantly. This was despite intravenous sedation.
IMPRESSION
1. Right radial access obtained.
2. Severe tortuosity in the axillary, subclavian and innominate artery
system prohibitive to catheter placement.
3. Moderate plaque burden at the ostium of the right common carotid artery.
PLAN
1. We will discuss the case further with Dr. xxx and consider obtaining a
CT angiogram of the thoracic aorta and left subclavian artery.
2. If anatomy is favorable, will consider re-approach via the left radial
approach for coronary angiography and possible intervention.
I'm in need of some expert advise on this case below. Any help is appreciated.
INDICATION FOR TEST
Abnormal nuclear stress test.
PROCEDURES PERFORMED
1. Right radial access.
2. Selective catheter placement and imaging of the right brachial artery.
3. Selective catheter placement and imaging of the right axillary artery.
4. Selective catheter placement and imaging of the subclavian artery.
5. Selective catheter placement and imaging of the right innominate artery.
REPORT
The patient was brought to the cath lab and, due to 100% infrarenal aortic
occlusion, the decision was made to proceed via the right radial approach.
Allen test was negative. The right radial artery was cannulated using a
micropuncture technique, and a 4-French Microglide sheath was placed. The
wire, unfortunately, would not traverse past the axillary artery. At this
point, after administration of the radial cocktail, including verapamil,
nitroglycerin and heparin, the 4-French glide catheter was placed into that
space. Direct injection of the catheter revealed a patent brachial artery,
patent axillary artery with moderate disease. Upon continuation of wire
placement into the subclavian artery, there appeared to be significant
tortuosity and two S-type bends. At this point, the glide catheter was
placed selectively into the distal subclavian artery. At this point, it was
noted that there was a large plaque burden at the origin of the right common
carotid artery. In addition, after the common carotid artery, the innominate
artery does make a 90-degree bend retrograde. At this point, the catheter
would not traverse any further. Due to the significant nature and severe
tortuosity with additional plaque burden near the ostium of the carotid
artery, the catheter and all wire equipment was removed. In addition, the
patient was fairly non-cooperative during the procedure and managed to break her restraints and move her arm constantly. This was despite intravenous sedation.
IMPRESSION
1. Right radial access obtained.
2. Severe tortuosity in the axillary, subclavian and innominate artery
system prohibitive to catheter placement.
3. Moderate plaque burden at the ostium of the right common carotid artery.
PLAN
1. We will discuss the case further with Dr. xxx and consider obtaining a
CT angiogram of the thoracic aorta and left subclavian artery.
2. If anatomy is favorable, will consider re-approach via the left radial
approach for coronary angiography and possible intervention.
