Right groin was prepped and draped in a sterile fashion. Using a
Doppler guided access needle the right common femoral artery was
entered and a JB1 angiographic catheter was advanced to the aortic
arch. Selective catheterization of the right subclavian artery was
performed. A 70 cm long 6.0 French vascular sheath was inserted. The
JB1 angiographic catheter was then subselectively advanced into the
subclavian artery, after placement of a TAD 0.018 platinum tip
guidewire this catheter was then exchanged for a 6 French Neuron
guiding catheter which was positioned in the upper right vertebral
artery, above the skull base. Moderate vasospasm was noted and
intra-arterial verapamil was administered. The Neuron catheter was
used to provide stability to a 150 cm long Renegade microcatheter
which was advanced over a Synchro pre-shaped angled guidewire and
into a distal posterior cerebral artery branch on the left through
the left P1 segment. Additional vasospasm was noted and additional
intra-arterial verapamil was administered at this point. A Neuroform
4.5 mm expanded diameter 20 mm long intracranial stent was then
positioned with the distal aspect of the stent near the distal P1
segment and the proximal aspect of the stent in the distal basilar
artery, and deployed. An Excelsior 10 microcatheter was advanced over
a Synchro standard pre-shaped guidewire and the interstices of the
Neuroform stent were crossed entering the basilar artery aneurysm.
Endovascular coiling of the aneurysm was then carried out as
described below. Additional followup angiography was then performed
as described. At completion an AngioSeal vascular closure device was
applied to the right common femoral artery with complete hemostasis.
The patient was then taken to PACU and subsequently to the
neuroscience ICU.
HOW WOULD YOU CODE THIS?
THANKS
Doppler guided access needle the right common femoral artery was
entered and a JB1 angiographic catheter was advanced to the aortic
arch. Selective catheterization of the right subclavian artery was
performed. A 70 cm long 6.0 French vascular sheath was inserted. The
JB1 angiographic catheter was then subselectively advanced into the
subclavian artery, after placement of a TAD 0.018 platinum tip
guidewire this catheter was then exchanged for a 6 French Neuron
guiding catheter which was positioned in the upper right vertebral
artery, above the skull base. Moderate vasospasm was noted and
intra-arterial verapamil was administered. The Neuron catheter was
used to provide stability to a 150 cm long Renegade microcatheter
which was advanced over a Synchro pre-shaped angled guidewire and
into a distal posterior cerebral artery branch on the left through
the left P1 segment. Additional vasospasm was noted and additional
intra-arterial verapamil was administered at this point. A Neuroform
4.5 mm expanded diameter 20 mm long intracranial stent was then
positioned with the distal aspect of the stent near the distal P1
segment and the proximal aspect of the stent in the distal basilar
artery, and deployed. An Excelsior 10 microcatheter was advanced over
a Synchro standard pre-shaped guidewire and the interstices of the
Neuroform stent were crossed entering the basilar artery aneurysm.
Endovascular coiling of the aneurysm was then carried out as
described below. Additional followup angiography was then performed
as described. At completion an AngioSeal vascular closure device was
applied to the right common femoral artery with complete hemostasis.
The patient was then taken to PACU and subsequently to the
neuroscience ICU.
HOW WOULD YOU CODE THIS?
THANKS