# Coiling of first intercostal artery



## maryann1224@bellsouth.net (May 22, 2012)

NEED ASSISTANCE PLEASE WITH THE CODING OF THIS COILING...I HAVE INCLUDED THE INTERVENTION
 PART OF THE REPORT..THANK YOU FOR YOUR HELP.......


1. left heart catheterization
2.  Left ventriculogram.
3.  Coronary angiography.
4.  Internal mammary angiography.
5.  Right heart catheterization.
6.  Coiling of the first intercostal artery.
7.  Conscious sedation.

CLINICAL HISTORY:
The patient is a 75-year-old patient who is followed by my
partner, He has a history of coronary
arterial disease and chronic shortness of breath and chest pain.
He has undergone mammary artery bypass of the left anterior
descending artery as well as several stenting procedures involving
the first diagonal vessel, posterior descending artery and
posterolateral branch.  The patient is known to have a large first
intercostal branch off the mammary artery with suspected steel
from the left anterior descending artery distribution.  He is
referred for repeat left and right heart catheterization with
potential coiling of the first intercostal vessel.

INTERVENTION:
Based on findings at diagnostic catheterization, and after
discussing the case at length with his primary cardiologist and
with the patient prior to the procedure regarding coiling of the
first intercostal branch, we proceeded with the intervention.  5000
units of heparin were administered and a BB1 mammary guide
catheter was used to engage the left internal mammary artery.  A
long run through wire was then advanced into the intercostal
branch and over the run through wire, a Renegade catheter was
advanced into the mid to distal intercostal vessel.  I then
advanced a 3 x 3.3 mm Vortex Diamond coil into the intercostal
branch proximal to any major size branches.  The coil was deployed
and we subsequently deployed four more Vortex coils.  Following
coil deployment, a Renegade catheter was removed and we performed
final angiography.  We had TIMI-2 flow distal to the coils while
the patient remained therapeutic on heparin.  We continued to have
TIMI-3 flow throughout the length of the mammary artery with no
evidence of an ostial vessel injury at site of guide engagement.
Manual pressure will be held for hemostasis when the ACT is less
than 180.

IMPRESSION:
1.  MODERATE TO SEVERE LEFT VENTRICULAR DYSFUNCTION.
2.  SEVERE SECONDARY PULMONARY HYPERTENSION.
3.  3+ MITRAL REGURGITATION.
4.  PATENT STENTS IN THE LAD, PDA AND POSTEROLATERAL BRANCHES.
5.  PATENT MAMMARY TO LAD GRAFT.
6.  MODERATELY LARGE FIRST INTERCOSTAL BRANCH WITH SUSPECTED
    CORONARY STEEL.
7.  SUCCESSFUL COILING OF THE FIRST INTERCOSTAL


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## jewlz0879 (May 23, 2012)

Coil Embolization
37204
75894-26

HTH!


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## maryann1224@bellsouth.net (May 23, 2012)

thank you so much!!!


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