Danny, Theresa,
Thru the right radial artery he engaged the right coronary artery. The catheterwas exchanged and multiple attempts were made to engage the left main, but proved to be unsuccessful thru the radial approach. After 15-20 minutes I decided to to exchange to the right femoral artery and a #6 french sheath was introduced and secured in place. The radial sheath was removed at that time and radial band placed with good hemostasis. We started with a JL 3.5 diagnostic catheter, the left main inttubated and imaged.. We exchanged to pigtail in the LV gram was obtained.
Intervention:
After starting the patient on angiomax antithrombolytic medication a JR-4 catheter inserted in the r coronary intubated. Stents palced in the proximal RCA and 2 placed in the posterolateral branch. After removing the balloon a couple pictures were taken after IC nitroglycerin. Timi flow was 3 but after the wire was removed TIMI flow went to 2, attempted to re-engage, was unsuccessful and a proximal RCA dissection was noticed and dissected all the way back to the the ostium of the RCA and could not re-establish the wire thru the distal RCA.
Patients blood pressure dropped and an IABP was placed and a 5 french venous sheath placed into the left common femoral vein.. After stabilizing the patient, multiple attempts were made using a BMW wire, choice PT floppy tip wire and the pilot 50 wire to cross the proximal RCA were unsuccessful. Patient was stable on IABP and emergently transferred to another institution for CABG.
The above are the highlights of the report.
So far we have coded 93458-26, 33967,36556,92980 RC.
There is also always discussion about the IC nitro and the thrombolytics. Could someone advise me to a reference or MC policy and both of those topics?
MJ