TWilliam2019
Guru
Procedure(s):
RETROGRADE RIGHT COMMON CAROTID STENT
Procedure list in detail:
Ultrasound guided right common femoral artery access
Arch aortogram
Right carotid arteriogram
Balloon angioplasty and stent of the right proximal common carotid artery with a 7mm x 16mm iCAST I am thinking 37217
Indications:
64 yo male with history of neck radiation and 99% stenosis of the right proximal common carotid artery, known left common carotid artery and left subclavian and axillary artery occlusions-high open surgical risk.
Implants:
Implant Name Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used Action
Icast covered stent 46983020 Right 1 Implanted
Procedure Details:
After consent was obtained the patient was taken to the operative suite and laid in the supine position. He was placed under general anesthesia and endotracheally intubated. The right neck and bilateral groins were prepped and draped in the usual sterile fashion. A proper timeout was performed and agreed upon by all parties present. The ultrasound was used to gain access of the right common femoral artery using a micropuncture technique.Ultrasound-guided puncture was performed of the right common femoral artery using a micropuncture technique. Duplex was used to survey the site for vessel selection and puncture was performed under real-time ultrasound imaging. Imaging was documented of the guidance and placed in the patient's record. Micropuncture wire advanced into the artery and a five French sheath was placed and flushed with heparinized saline. Systemic heparin was given and allowed to circulate to achieve an ACT greater than 250. A Glidewire and pigtail catheter were guided into the ascending aorta using fluoroscopy. The image intensifier was moved into the LAO position and wire was removed. An aortogram of the aortic arch was then performed which showed a type I patent aortic arch. The innominate artery and right subclavian artery are patent without stenosis. The right proximal common carotid artery is tortuous and has a 99% stenosis at its origin as well as approximately 50 to 60% stenosis in the mid common carotid artery. The right external carotid artery is occluded approximately 1 cm past its origin. The right internal carotid artery is patent without significant stenosis. The left common carotid artery is occluded. The left vertebral artery appears patent the left subclavian artery appears patent proximally but then occludes and the left axillary artery appears occluded. The pigtail catheter was removed over the wire and five French sheath exchanged for a 7 French by 90 cm sheath and flushed with heparinized saline. The H1 catheter used to select out the innominate artery with a Glidewire and sheath was advanced into the innominate artery. The Glidewire and H1 catheter were removed. A 0.014 wire was used to cross the proximal common carotid artery and mid common carotid artery lesions and was advanced into the internal carotid artery. A 5 mm spider filter was guided over the 0.014 wire into the internal carotid artery the wire was removed and the 5 mm spider filter was safely deployed in the internal carotid artery. A 4 mm x 30 mm balloon was then used to balloon angioplasty the proximal common carotid artery for predilation and then was removed. The proximal common carotid artery was then stented with a 7 mm x 16 mm I cast and balloon was removed leaving the stent in place. Final arteriography of the right carotid artery now shows patent proximal common carotid artery stent with no residual stenosis. The mid common carotid artery lesion now appears to be 40 to 50% stenosed in a tortuous segment but does not appear to be flow-limiting. The internal carotid artery remains patent throughout. The spider filter was then recaptured and removed. The sheath was guided back into the right external iliac artery over the Glidewire. Arteriogram at the access site shows no access site complications. The access site was closed with a ProGlide successfully. A single 4-0 Monocryl placed at the access site. The patient tolerated the procedure well sterile dressing placed. The patient was awakened from general anesthesia and extubated in the operating room without difficulty and transferred to recovery room with no changes in preoperative neuro exam.
RETROGRADE RIGHT COMMON CAROTID STENT
Procedure list in detail:
Ultrasound guided right common femoral artery access
Arch aortogram
Right carotid arteriogram
Balloon angioplasty and stent of the right proximal common carotid artery with a 7mm x 16mm iCAST I am thinking 37217
Indications:
64 yo male with history of neck radiation and 99% stenosis of the right proximal common carotid artery, known left common carotid artery and left subclavian and axillary artery occlusions-high open surgical risk.
Implants:
Implant Name Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used Action
Icast covered stent 46983020 Right 1 Implanted
Procedure Details:
After consent was obtained the patient was taken to the operative suite and laid in the supine position. He was placed under general anesthesia and endotracheally intubated. The right neck and bilateral groins were prepped and draped in the usual sterile fashion. A proper timeout was performed and agreed upon by all parties present. The ultrasound was used to gain access of the right common femoral artery using a micropuncture technique.Ultrasound-guided puncture was performed of the right common femoral artery using a micropuncture technique. Duplex was used to survey the site for vessel selection and puncture was performed under real-time ultrasound imaging. Imaging was documented of the guidance and placed in the patient's record. Micropuncture wire advanced into the artery and a five French sheath was placed and flushed with heparinized saline. Systemic heparin was given and allowed to circulate to achieve an ACT greater than 250. A Glidewire and pigtail catheter were guided into the ascending aorta using fluoroscopy. The image intensifier was moved into the LAO position and wire was removed. An aortogram of the aortic arch was then performed which showed a type I patent aortic arch. The innominate artery and right subclavian artery are patent without stenosis. The right proximal common carotid artery is tortuous and has a 99% stenosis at its origin as well as approximately 50 to 60% stenosis in the mid common carotid artery. The right external carotid artery is occluded approximately 1 cm past its origin. The right internal carotid artery is patent without significant stenosis. The left common carotid artery is occluded. The left vertebral artery appears patent the left subclavian artery appears patent proximally but then occludes and the left axillary artery appears occluded. The pigtail catheter was removed over the wire and five French sheath exchanged for a 7 French by 90 cm sheath and flushed with heparinized saline. The H1 catheter used to select out the innominate artery with a Glidewire and sheath was advanced into the innominate artery. The Glidewire and H1 catheter were removed. A 0.014 wire was used to cross the proximal common carotid artery and mid common carotid artery lesions and was advanced into the internal carotid artery. A 5 mm spider filter was guided over the 0.014 wire into the internal carotid artery the wire was removed and the 5 mm spider filter was safely deployed in the internal carotid artery. A 4 mm x 30 mm balloon was then used to balloon angioplasty the proximal common carotid artery for predilation and then was removed. The proximal common carotid artery was then stented with a 7 mm x 16 mm I cast and balloon was removed leaving the stent in place. Final arteriography of the right carotid artery now shows patent proximal common carotid artery stent with no residual stenosis. The mid common carotid artery lesion now appears to be 40 to 50% stenosed in a tortuous segment but does not appear to be flow-limiting. The internal carotid artery remains patent throughout. The spider filter was then recaptured and removed. The sheath was guided back into the right external iliac artery over the Glidewire. Arteriogram at the access site shows no access site complications. The access site was closed with a ProGlide successfully. A single 4-0 Monocryl placed at the access site. The patient tolerated the procedure well sterile dressing placed. The patient was awakened from general anesthesia and extubated in the operating room without difficulty and transferred to recovery room with no changes in preoperative neuro exam.