This is the last one for this week. Thanks to anyone that has helped with any of my posts. Have a great day!
SERVICES PROVIDED:
1. Cerebrocervical arch.
2. Left internal carotid artery angiogram.
3. Right internal carotid angiogram.
4. Left vertebral angiogram.
5. Intravenous moderate sedation.
CATHETER POSITIONING:
1. From a right common femoral artery approach, a 5-French pigtail catheter was placed in the ascending aorta.
2. The catheter was exchanged for a 5-French angled glide catheter which was positioned in the right common carotid artery.
3. The catheter was repositioned into the left internal carotid artery.
4. The catheter was repositioned into the left vertebral artery.
PROCEDURE/METHODS: The procedure was explained in detail to the patient. Potential risks, benefits, and alternate therapies were discussed. All questions were answered and informed consent was obtained.
The patient's right groin was examined with ultrasound showing patency of the right common femoral artery. The right groin was sterilely scrubbed, prepped and draped in the standard fashion. Local anesthetic was applied using 2% Xylocaine. Using ultrasound guidance and a micropuncture needle, access was gained into the right common femoral artery. Ultrasound was used to visualize the needle entering into the lumen of the vessel. Percutaneous access was dilated to accept a 5-French introducer sheath through which a 5-French pigtail catheter was guided fluoroscopically over a wire into the ascending aorta. An LAO study of the aortic arch and great vessels was then obtained.
The catheter was then exchanged for a 5-French angled glide catheter which was guided fluoroscopically over a wire into the right common carotid artery. Biplane studies of the intracranial branches of the right common carotid artery was performed.
The catheter was repositioned into the left internal carotid artery and biplane and multiple oblique views of the left internal carotid artery were performed.
Catheter was withdrawn and repositioned into the left vertebral artery where AP and lateral views of the vertebrobasilar blood flow were performed.
The catheter and sheath were then removed and hemostasis achieved at the right groin using the closure device.
FINDINGS: The cerebrocervical arch shows normal arterial anatomy. The origins of the great vessels are widely patent without evidence of stenosis. Both vertebral arteries are normal and equal in caliber.
LEFT INTERNAL CAROTID ARTERY: The left internal carotid artery angiogram shows coil inclusion of the left posterior communicating artery aneurysm. There is no angiographic evidence of recanalization of the coiled aneurysm. The distal internal carotid artery appears normal in appearance. There is no evidence of an additional aneurysm involving the arterial intracranial vessels. There is no evidence of a distal emboli.
RIGHT COMMON CAROTID ARTERY: The right common carotid artery angiogram demonstrates no evidence of an aneurysm arising from the intracranial distribution of the right common carotid artery.
LEFT VERTEBRAL ARTERY: The vertebrobasilar angiogram shows no evidence of aneurysm formation.
IMPRESSION: OCCLUSION OF THE LEFT POSTERIOR COMMUNICATING ARTERY ANEURYSM SECONDARY TO ENDOVASCULAR COILING. NO ANGIOGRAPHIC EVIDENCE OF NEW ANEURYSM FORMATION OR RECANALIZATION OF THE COILED ANEURYSM.
SERVICES PROVIDED:
1. Cerebrocervical arch.
2. Left internal carotid artery angiogram.
3. Right internal carotid angiogram.
4. Left vertebral angiogram.
5. Intravenous moderate sedation.
CATHETER POSITIONING:
1. From a right common femoral artery approach, a 5-French pigtail catheter was placed in the ascending aorta.
2. The catheter was exchanged for a 5-French angled glide catheter which was positioned in the right common carotid artery.
3. The catheter was repositioned into the left internal carotid artery.
4. The catheter was repositioned into the left vertebral artery.
PROCEDURE/METHODS: The procedure was explained in detail to the patient. Potential risks, benefits, and alternate therapies were discussed. All questions were answered and informed consent was obtained.
The patient's right groin was examined with ultrasound showing patency of the right common femoral artery. The right groin was sterilely scrubbed, prepped and draped in the standard fashion. Local anesthetic was applied using 2% Xylocaine. Using ultrasound guidance and a micropuncture needle, access was gained into the right common femoral artery. Ultrasound was used to visualize the needle entering into the lumen of the vessel. Percutaneous access was dilated to accept a 5-French introducer sheath through which a 5-French pigtail catheter was guided fluoroscopically over a wire into the ascending aorta. An LAO study of the aortic arch and great vessels was then obtained.
The catheter was then exchanged for a 5-French angled glide catheter which was guided fluoroscopically over a wire into the right common carotid artery. Biplane studies of the intracranial branches of the right common carotid artery was performed.
The catheter was repositioned into the left internal carotid artery and biplane and multiple oblique views of the left internal carotid artery were performed.
Catheter was withdrawn and repositioned into the left vertebral artery where AP and lateral views of the vertebrobasilar blood flow were performed.
The catheter and sheath were then removed and hemostasis achieved at the right groin using the closure device.
FINDINGS: The cerebrocervical arch shows normal arterial anatomy. The origins of the great vessels are widely patent without evidence of stenosis. Both vertebral arteries are normal and equal in caliber.
LEFT INTERNAL CAROTID ARTERY: The left internal carotid artery angiogram shows coil inclusion of the left posterior communicating artery aneurysm. There is no angiographic evidence of recanalization of the coiled aneurysm. The distal internal carotid artery appears normal in appearance. There is no evidence of an additional aneurysm involving the arterial intracranial vessels. There is no evidence of a distal emboli.
RIGHT COMMON CAROTID ARTERY: The right common carotid artery angiogram demonstrates no evidence of an aneurysm arising from the intracranial distribution of the right common carotid artery.
LEFT VERTEBRAL ARTERY: The vertebrobasilar angiogram shows no evidence of aneurysm formation.
IMPRESSION: OCCLUSION OF THE LEFT POSTERIOR COMMUNICATING ARTERY ANEURYSM SECONDARY TO ENDOVASCULAR COILING. NO ANGIOGRAPHIC EVIDENCE OF NEW ANEURYSM FORMATION OR RECANALIZATION OF THE COILED ANEURYSM.
