DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Bilateral carotid artery stenosis.
POSTOPERATIVE DIAGNOSIS: Bilateral carotid artery stenosis.
PROCEDURE PERFORMED: Thoracic arch angiography and selective angiography of right innominate artery and bilateral carotid arteries.
SURGEON: John Doe, MD
ANESTHESIA: Local anesthesia with IV sedation.
DESCRIPTION OF PROCEDURE: The patient was brought to the angio suite and was placed in the supine position. The patient received IV sedation. Both groins were prepped and draped in the usual sterile manner. Xylocaine 1% was infiltrated into the right groin over the skin and subcutaneous tissues and local anesthesia was obtained.
Then, a percutaneous stick was made with an 18-gauge needle into the right common femoral artery. Once the blood flow was seen, we introduced a 0.035 J wire. This was advanced all the way into the thoracic arch. We then placed a 5-French sheath. A 5-French pigtail catheter was threaded over the guidewire. This was placed in the proximal thoracic arch and then we did arch injection and arch angiography.
The pigtail catheter was removed, and we used a JB-2 catheter to select the right innominate artery and injection was made here. We selected the right carotid artery, and multiple injections were made and carotid angiography films were obtained. The JB-2 catheter was pulled back, and we accessed the left common carotid artery and selective left carotid angiography was accomplished in several views.
At the end of the procedure, the JB-2 catheter and the sheath were removed, and we held pressure in the right groin until hemostasis was obtained. The patient was transferred out of the angio suite in a stable condition.
ANGIOGRAPHY FINDINGS: The thoracic arch appears to be widely patent without any stenosis. Right innominate artery as well as subclavian arteries are widely patent. Right vertebral artery is tortuous, but there is no obvious stenosis seen at its origin. The right common carotid artery is normally patent.
At the origin of the right internal carotid artery, there is plaque formation causing 50-60% stenosis. The distal right internal carotid artery is fairly smooth and patent. The left common carotid artery has mild plaque formation at its origin from the thoracic arch without any stenosis.
There is plaque formation at the left carotid bifurcation extending into the internal carotid artery causing 40% stenosis. The plaque appears to be somewhat irregular.
FINAL IMPRESSION:
1. There is plaque formation at the right carotid bifurcation extending into the internal carotid artery causing 50-60% stenosis.
2. There is plaque formation at the left carotid bifurcation extending into the left internal carotid artery causing 40% stenosis.
