Thrombectomy without intervention.
Sorry it has taken me awhile to post. Thanks for your help.
Indications: Acute inferior myocardial infarction.
With informed consent, the patient was prepped and draped in a sterile fashion. Lidocaine 1% was infiltrated in the right femoral triangle for anesthesia. Using a modification of the seldinger technique, the right femoral artery was entered and a 6-french sheath was introduced and secured. Through this, selective coronary arteriography was performed usaing a preformed 6-french judkins catheter. Subsequently, a 6-french pigtail catheter was used to perform left heart catheterization and left ventriculogram. A JL5 catheter was required to engage the left main coronary ostium. Finally these catheters were withdrawn and we moved to intervention.
RESULTS OF DIAGNOSTIC CATHETERIZATION: Left ventricular end diastolic pressure was elevated at 26 mmHg. Blood pressures: LV 197/26, AL 197/101.
Left ventriculogram was performed in the right anterior oblique projection. Excursion from end-diastole demonstrates hypokinesis of the inferior basal segments. All other segments are hyperdynamic. Left ventricualr ejection fraction is 45% to 50%.
Coronary arteriogram was performed in multiple projections. The left main coronary is a very short vessel bifurcation in the left anterior descending and circumflex coronary arteries.
Left anterior descending coronary artery has a critical, concentric stenosis just distal to the bifurcation of the first diagonal and first septal branches. There is TIMI-3 flow to the distal vessel. The distal vessel is somewhat irregular due to diffuse, noncritical coronary disease. The first diagonal branch is diffusely diseased but is a very small vessel.
The circumflex coronary system has a large obtuse marginal branch which has approx 85% - 90% stenosis at its midportion. Again, it is an eccentric area of stenosis. There is TIMI -3 flow to the distal vessel.
The right coronary artery is occluded in its middle portion. There is TIMI-2 flow to the distal vessel. In addition, there is 70% stenosis of the proximal vessel which did not seem to be involved with the flow defect that represents a large thrombus in the midportion of the vessel.
Coronary intervention with AngioJet thrombectomy:
An indwelling 6-french JR4 guide catheter in the ascending aorta. It was flushed. The right coronary ostium was engaged. The patient was pretreated with Integrilin. A 0.014 by 190 cm BMW wire was introduced and advanced up to the right coronary artery beyond the area of stenosis. Ovet this and Angiocatheter was introduced and advanced. Two passes were made. This successfully produced TIMI -3 flow in the area where the flow was TIMI 2 prior to that. BECAUSE THE PATIENT HAS 3-VESSEL DISEASE AND POSSIBLE CORONARY ARTERY BYPASS SURGERY WAS ANGICIPATED, NO BALLOON ANGIOPLASTY OR STENT WAS DONE AT THIS TIME. The sheath was secured with silk suture.
Can the thrombectomy be billed since there was no intervention with balloon or stent?
