PROCEDURES PERFORMED: Bilateral carotid/cerebral and aortic arch angiogram

CLINICAL HISTORY:

COMPARISON: No previous study available for comparison.

ANESTHESIA: 41 minutes conscious sedation using 1illigrams of IV Versed and 0 micrograms of IV fentanyl. Independent trained observer was present during the entire duration of the conscious sedation for monitoring. 1% lidocaine for local anesthesia

TOTAL FLUOROSCOPY TIME: 8.6 minutes

TOTAL CONTRAST USED: 81 milliliters of Omnipaque 300.

DESCRIPTION OF PROCEDURE: A time out was performed to verify patient identity, procedure, site, side, and level as applicable. After obtaining informed consent, the patient was prepped and draped in the usual sterile manner in supine position. After applying local anesthesia and making a small incision, the right common femoral artery was accessed using Seldinger technique using a micropuncture needle under real-time ultrasound guidance. Ultrasound image of the right common femoral artery was documented. The system was then converted to a .035 system and a 6-French sheath was advanced into the right common femoral artery. A 5 F Pigtail catheter was placed into the ascending aorta, and aortic arch angiogram was performed in the LAO projection. A 4-French soft glide tapered end catheter was then advanced into the aortic arch over the wire. Over a Terumo Glidewire, the catheter was used to selectively catheterize bilateral common carotid arteries. Bilateral carotid cerebral angiogram images were obtained in various projections. Afterwards, the catheter and the sheath were removed and a Mynx device was used to achieve hemostasis in the right groin. The patient tolerated the procedure without any immediate complications.

FINDINGS: Great vessels are widely patent with a dominant right vertebral artery. The left smaller vertebral artery is patent throughout its course. The origins of the great vessels are widely patent. There is incidental finding of moderate atherosclerotic change involving the right distal external iliac artery on the sheath angiogram prior to the Mynx device deployment after the angiogram.

Right side: The common carotid artery is widely patent. There is chronic total occlusion of the origin of the right internal carotid artery with hypertrophied external carotid artery branches. No definite filling of the distal internal carotid artery is seen with the injection into the right common carotid artery.

Left side: There is a focal 70 to 75% stenosis of the left proximal internal carotid artery 2 cm distal to the origin (using the NASCET criteria). The distal internal carotid artery segments are widely patent. Intracranial circulation is unremarkable, as described in the previous CT angiogram of the head.

IMPRESSION: