JessicaSlone
New
I'm unsure how to go about coding this one so I would appreciate any help that could be given.
We did an open access to the carotid. Below is the procedure note:
The right side of the neck and face, and the right groin were cleaned, prepped and draped in sterile surgical fashion using Chlorhexidine.
US guided access to the right CFV was performed in routine fashion using a micro access kit. This was upsized over a wire to an 8F sheath, and this was flushed with Heparinized saline.
A transverse incision was made over the lower anterior neck between the two heads of the sternocleidomastoid muscle. Bovie cautery was used to secure hemostasis and deepen the incision through the skin, subcutaneous tissue, and platysma.
The heads of the SCM were separated, and dissection carried down to the Jugular vein, which was retracted laterally.
The Common carotid artery was identified, skeletonized, and looped with a vessel loop at the level of the clavicle.
The patient was systemically heparinized, and after achieving a therapeutic ACT, an adventitial U-stitch was placed around the planned access site.
The CCA was accessed with the micro needle, to the mark on the needle. The micro wire was advance to allow about 5 cm of access into the artery, and the needle was removed and a micro sheath was advanced over the wire. The wire was removed, and a side port was attached to the micro sheath, and gently flushed with Heparinized saline.
A carotid angiogram was performed with an oblique projection, and the wire was advanced into the External Carotid Artery under fluoroscopic guidance. The micro sheath was advanced over the wire into the ECA, and the wire was replaced with an 0.035" J wire.
The micro sheath was removed, and the sheath was replaced with an 8F sheath, after which the J wire and dilator were removed. The sheath was flushed with Heparinized saline, and connected to the neuro protection system, and flow-reversal was confirmed.
Orthogonal oblique imaging was performed to the Carotid artery, to identify the bifurcation and confirm the location, and extent of ICA plaque.
The micro wire was advanced into the carotid siphon, and a balloon was advanced across the lesion. Angioplasty of the lesion was performed.
The balloon was removed, and a stent was advanced over the wire, and deployed across the lesion. Flow reversal was continued for a further 2-3 mins.
Completion imaging was performed, after which the catheters and wires were removed and the U-stitched was tied down.
The incision was closed in layers using interrupted Vicryl sutures for the platysma, and a running subcuticular Vicryl closure for the skin.
Dressings were applied.
Pressure was applied at the femoral access till hemostatic.
Findings: The right common carotid artery was widely patent. The internal carotid artery had a stenosis of about 80% by CTA.
The remainder of the ICA was widely patent.
The ECA showed some ostial plaque, but was patent, as were the ECA branches.
Following the angioplasty and stent, the ICA was widely patent, with no residual stenosis. There was a spasm noted at the distal stent from sizing that is expected to relax over time.
From pre-procedure imaging and risk assessment :
Type of aortic arch : III
Calcium circumference of lesion : 30%
Lesion length : 15 mm
Flow reversal time : 12 min
Balloon used : 5 X 20.
Stent placed : 8-6 X 30 Enroute tapered stent.
We did an open access to the carotid. Below is the procedure note:
The right side of the neck and face, and the right groin were cleaned, prepped and draped in sterile surgical fashion using Chlorhexidine.
US guided access to the right CFV was performed in routine fashion using a micro access kit. This was upsized over a wire to an 8F sheath, and this was flushed with Heparinized saline.
A transverse incision was made over the lower anterior neck between the two heads of the sternocleidomastoid muscle. Bovie cautery was used to secure hemostasis and deepen the incision through the skin, subcutaneous tissue, and platysma.
The heads of the SCM were separated, and dissection carried down to the Jugular vein, which was retracted laterally.
The Common carotid artery was identified, skeletonized, and looped with a vessel loop at the level of the clavicle.
The patient was systemically heparinized, and after achieving a therapeutic ACT, an adventitial U-stitch was placed around the planned access site.
The CCA was accessed with the micro needle, to the mark on the needle. The micro wire was advance to allow about 5 cm of access into the artery, and the needle was removed and a micro sheath was advanced over the wire. The wire was removed, and a side port was attached to the micro sheath, and gently flushed with Heparinized saline.
A carotid angiogram was performed with an oblique projection, and the wire was advanced into the External Carotid Artery under fluoroscopic guidance. The micro sheath was advanced over the wire into the ECA, and the wire was replaced with an 0.035" J wire.
The micro sheath was removed, and the sheath was replaced with an 8F sheath, after which the J wire and dilator were removed. The sheath was flushed with Heparinized saline, and connected to the neuro protection system, and flow-reversal was confirmed.
Orthogonal oblique imaging was performed to the Carotid artery, to identify the bifurcation and confirm the location, and extent of ICA plaque.
The micro wire was advanced into the carotid siphon, and a balloon was advanced across the lesion. Angioplasty of the lesion was performed.
The balloon was removed, and a stent was advanced over the wire, and deployed across the lesion. Flow reversal was continued for a further 2-3 mins.
Completion imaging was performed, after which the catheters and wires were removed and the U-stitched was tied down.
The incision was closed in layers using interrupted Vicryl sutures for the platysma, and a running subcuticular Vicryl closure for the skin.
Dressings were applied.
Pressure was applied at the femoral access till hemostatic.
Findings: The right common carotid artery was widely patent. The internal carotid artery had a stenosis of about 80% by CTA.
The remainder of the ICA was widely patent.
The ECA showed some ostial plaque, but was patent, as were the ECA branches.
Following the angioplasty and stent, the ICA was widely patent, with no residual stenosis. There was a spasm noted at the distal stent from sizing that is expected to relax over time.
From pre-procedure imaging and risk assessment :
Type of aortic arch : III
Calcium circumference of lesion : 30%
Lesion length : 15 mm
Flow reversal time : 12 min
Balloon used : 5 X 20.
Stent placed : 8-6 X 30 Enroute tapered stent.