Angioplasty
Not enough information. Can you post the report?
Jim Pawloski, CIRCC
1. Surgical Introduction of Needle and catheter into the right common femoral artery.
2. Selective Catheter Placment, arterial system, third order, brachiocephalic branch, into the right internal carotid artery.
3. Angiography, right internal carotid artery, unilateral selective frontal and lateral digital arteriographic views of skull frontal and lateral digital arteriographic views of skull.
4. Angiography, right internal carotid artery, unilateral selective, Rhese and Schuller's Digital arteriographic views of skull.
5. Selective catheter placement, arterial system, first order, aortic branch, into the left common carotid artery.
6. Angiography, left common carotid artery, unilateral selective, Rhese Digital Arteriographic View of Skull.
7. Selective catheter placement, arterial system, beyond third order, brachiocephalic branch, into M2 branch of right middle cerebral artery.
8. Angiography, right internal carotid artery, unilateral selection, Rhese Digital Arteriographic view of skull following placement fo Marksman Delivery Catheter into right middle Cerebral Artery M2 Branch.
9. Angiography, right internal carotid artery, unilateral selective, Rhese Digital Arteriographic View of Skull Following Deployment of 4.75 x 16 MM Pipeline Embolization Device.
10. Angiography, right internal carotid Artery, unilateral selective, Rhese Digital Arteriographic view of Skull following Ballon Angioplasty of Deployed Pipeline Embolization Device.
11. Angiography, Right Internal Carotid Artery, Unilateral Selective, Rhese and Lateral Digital Arteriographic Views of Skull at Conclusion fo Pipeline Embolization Device Procedure.
ENDOVASCULAR SURGICAL PROCEDURES; Deployment fo 4.7 x 16 MM PIPELINE Embolization device through existing pipeline embolization device which had caused nearly complete occlusion fo superaclinoid right internal carotid artery wide-neck large Aneurysm. In addition Percutanesous transluminal Balloon Angioplasty Using a 4 MM Hyperform Balloon Angioplasty Catheter was Necessary to aid in proper deployment of the Pipeline device.
Description of Procedure: The patient was brought to the neural interventional operating room site and was placed upon the procedure table in a supine position. She received IV Prophylactic Ancef at the commencement of the procedure. IV neuroleptic anesthesia was induced and monitored by Dr. Koifman of anesthesiology at the commencement of the procedure. Later in the procedure this was converted to general laryngeal mask anethesia. The right groin was prepped and draped in a sterile fashion, and local anesthesia within the right inguinal entry site was effected by the intradermal injection of 1% lidocaine solution. Through this anesthestized skin entry zone, using standard Seldinger technique, a 6-Frency vascular introduction sheath was advanced into the right common femoral artery and was secured to the skin entry site with 2-0 silk suture. Contrast injection through the sheath revealed adequate puncture site anatomy to allow subsequent use of a percutanteous closure device. Coaxially through this sheath, a Simmons 2 Catheter was then advanced under fluroscopic guidance Coaxially through this sheath, a Simmons 2 Catheter was then advanced under fluroscopic guidance into the right internal carotid artery as well as the left common carotid artery where pre-embolization angiographic views of the skull were obtained as described above. These angiographic images reveal a small irregular residual aneurysm cavity associated with the right internal carotid artery supraclinoid large aneurysm that had been previously treated with Pipeline Embolization device placement. Approximately 90% occlusion of the original aneurysm cavity had apparently been achieved with the placement of the Pipeline device. There was still patency of the patient's right ophthalmic artery. On the left side there was still a 2 mm wide-neck A2 origin left anterior cerebral artery aneurysm that was too small and of the wrong anatomy to allow any endovascular teamtment at this time. The patient was placed under general larygeal mask anesthesia and was systemically heparinized. She had already been on aspirin and Effient prior to the commencement of this procedure. The 5-Frency Simmons 2 catheter was again advanced into the right internal carotid artery and this was exchanged over an exchange wire for a 6-Frency Neuron catheter which was advanced into the petrous portion of the right internal carotid artery. Coaxially through the neuron catheter a Marksman microcatheter was advanced under digital roadmap imaging into an M2 branch of the right middle cerebral artery past the previously placed Pipeline embolization device. Throught this Marksman catheter, a 4.75 diamter x 16 mm length Pipeline device was gradullay deployed within the existing Pipeline device. Repeat contrast injection through the Neuron catheter as described above revealed nearly complete expansion of the Pipeline device within the existing Pipeline device. The Marksman catheter was readvanced over the delivery wire of the Pipeline device and the delivery wire was removed. An Accelerator 10 exchange wire was advanced through the Marksman catheter and the Marksman catheter was exchanged for a HyperForm 4 mm balloon angioplasty cather which was expanded multiple times within the newly deployed Pipeline embolization device. Repeat contrast injection revealed excellent deployment and expansion of the New Pipeline Device. There again to be sluggish flow within the residual aneurysm cavity. There was maintained flow through the opthalamic artery. The balloon angioplasty catheter was removed and Rhese and lateral digital arteriographic imaging of the skull again revealed excellent placemnt and expansion of the new Pipeline embolization device and the small residual right ICA superaclinoid aneurysm cavity. There was what appreared to be a filling defect within the right anterior cerebral artery, but this was merely the appearance of unopacified blood flood flowing from right to left through the anterior communicating artery and was not an intraluminal thrombus. The lateral angiographic image of the skull revealed no new branch occulusions within the right anterior circulation. At the conclusion of the procedure the right groin catheter was removed and hemostasis was effected using an Angio-Seal device. No bleeding or hematoma was noted at the right groin puncture site which was then covered with antibiotic ointment and a Tegaderm dressing. The patient was awakened from general laryngeal mask anesthesia and was found to be grossly at her neurological baseline. She was then transported in stable condition to the intensive care unit for further monitoring and care.