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INDICATIONS: Angina pectoris.
Left heart catheterization, selective coronary angiography, bypass graft angiography with complex percutaneous intervention of the vein graft to the RCA, percutaneous intervention to the right PDA with placement of Resolute drug-eluting stents
HISTORY OF PRESENT ILLNESS: The patient is a 71-year-old with a history of hypertension, CAD, previous CABG with subsequent stents, presenting with escalating symptoms of typical angina. He had high risk performance on exercise stress testing with
inferior ischemia and is referred for diagnostic angiography. This was despite maximal medical therapy.
PROCEDURE: Informed consent was obtained, the patient understood the risks, benefits and alternatives of the procedure and agreed to proceed to proceed with the procedure. The right groin was prepped in the usual sterile fashion and 2% lidocaine
infused subcutaneously until adequate anesthesia ventricular was obtained. Right common femoral artery accessed using modified Seldinger technique of which a 6 French 11 cm sheath was placed without complication. Diagnostic JL4 and JR4 and IMA
catheters were used to perform selective coronary angiography and left heart catheterization. At the conclusion of the procedure, an Angio-Seal device was deployed without complication.
HEMODYNAMICS: Left ventricular end-diastolic pressure measured most 10 mmHg. There was no transaortic gradient on pullback.
CORONARY ANGIOGRAPHY:
LEFT MAIN: Mild disease.
LAD: Mild disease but it was totally occluded after the takeoff of a prominent diagonal. The distal vessel seen filled from a patent bypass graft with mild disease. The first diagonal mild disease.
LEFT CIRCUMFLEX: The left circumflex had mild disease with a prominent first marginal with mild disease.
RCA: Totally occluded proximally. Distal vessel was dominant and a prominent PL and PDA branches. There was an 80% focal type A stenosis seen in the RPDA. The vein graft to the RCA had a patent stent seen in its proximal portion. It was severely
degenerative and diseased in the mid and distal portions, extending into a 90% stenosis distally.
GRAFTS: The LIMA to LAD was patent.
SUMMARY: Critical multivessel coronary artery disease with high-grade native RPDA stenosis as well as critical degenerative disease and high-grade stenosis in the vein graft feeding the RCA.
Based on the patient's clinical presentation angiographic findings, we elected to proceed with complex angioplasty.
INTERVENTION: Angiomax was used for effective anticoagulation. An MPA 1 guide catheter was used to intubate the vein graft to the right coronary artery. A Runthrough wire was placed to the distal RPDA and a 2.5x12 Resolute was deployed to 14
atmospheres with an excellent angiographic result. Next, a FilterWire was then placed to the right PDA and deployed for protection. Copious amounts of intracoronary Nipride were utilized and a 3.5x38 Resolute drug-eluting stent was then deployed across
the complex stenosis in the degenerated vein graft. This was deployed to 18 atmospheres. Subsequent Nipride was used to prevent no refill and an excellent angiographic result was revealed with TIMI-III flow. The FilterWire was removed with the
retrieval device without complication.
SUMMARY:
1. Successful percutaneous intervention of the native RPDA with placement of a Resolute drug-eluting stent.
2. Successful percutaneous intervention of the vein graft to the RCA with placement of a Resolute drug-eluting stent.
I have
93459-26-59
92928-RC
92937-RC Is this correct? Thanks Nancy
INDICATIONS: Angina pectoris.
Left heart catheterization, selective coronary angiography, bypass graft angiography with complex percutaneous intervention of the vein graft to the RCA, percutaneous intervention to the right PDA with placement of Resolute drug-eluting stents
HISTORY OF PRESENT ILLNESS: The patient is a 71-year-old with a history of hypertension, CAD, previous CABG with subsequent stents, presenting with escalating symptoms of typical angina. He had high risk performance on exercise stress testing with
inferior ischemia and is referred for diagnostic angiography. This was despite maximal medical therapy.
PROCEDURE: Informed consent was obtained, the patient understood the risks, benefits and alternatives of the procedure and agreed to proceed to proceed with the procedure. The right groin was prepped in the usual sterile fashion and 2% lidocaine
infused subcutaneously until adequate anesthesia ventricular was obtained. Right common femoral artery accessed using modified Seldinger technique of which a 6 French 11 cm sheath was placed without complication. Diagnostic JL4 and JR4 and IMA
catheters were used to perform selective coronary angiography and left heart catheterization. At the conclusion of the procedure, an Angio-Seal device was deployed without complication.
HEMODYNAMICS: Left ventricular end-diastolic pressure measured most 10 mmHg. There was no transaortic gradient on pullback.
CORONARY ANGIOGRAPHY:
LEFT MAIN: Mild disease.
LAD: Mild disease but it was totally occluded after the takeoff of a prominent diagonal. The distal vessel seen filled from a patent bypass graft with mild disease. The first diagonal mild disease.
LEFT CIRCUMFLEX: The left circumflex had mild disease with a prominent first marginal with mild disease.
RCA: Totally occluded proximally. Distal vessel was dominant and a prominent PL and PDA branches. There was an 80% focal type A stenosis seen in the RPDA. The vein graft to the RCA had a patent stent seen in its proximal portion. It was severely
degenerative and diseased in the mid and distal portions, extending into a 90% stenosis distally.
GRAFTS: The LIMA to LAD was patent.
SUMMARY: Critical multivessel coronary artery disease with high-grade native RPDA stenosis as well as critical degenerative disease and high-grade stenosis in the vein graft feeding the RCA.
Based on the patient's clinical presentation angiographic findings, we elected to proceed with complex angioplasty.
INTERVENTION: Angiomax was used for effective anticoagulation. An MPA 1 guide catheter was used to intubate the vein graft to the right coronary artery. A Runthrough wire was placed to the distal RPDA and a 2.5x12 Resolute was deployed to 14
atmospheres with an excellent angiographic result. Next, a FilterWire was then placed to the right PDA and deployed for protection. Copious amounts of intracoronary Nipride were utilized and a 3.5x38 Resolute drug-eluting stent was then deployed across
the complex stenosis in the degenerated vein graft. This was deployed to 18 atmospheres. Subsequent Nipride was used to prevent no refill and an excellent angiographic result was revealed with TIMI-III flow. The FilterWire was removed with the
retrieval device without complication.
SUMMARY:
1. Successful percutaneous intervention of the native RPDA with placement of a Resolute drug-eluting stent.
2. Successful percutaneous intervention of the vein graft to the RCA with placement of a Resolute drug-eluting stent.
I have
93459-26-59
92928-RC
92937-RC Is this correct? Thanks Nancy