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:
Frequently Asked Questions
What is a carotid angiogram?
A carotid angiogram is a diagnostic procedure that uses X-ray imaging to examine the carotid arteries, which supply blood to the brain. It involves injecting a contrast dye into the blood vessels to make them visible on the images. This procedure helps in detecting blockages, narrowing, or other abnormalities in the carotid arteries.
The procedure involves inserting a catheter, usually through the femoral artery in the groin, and guiding it to the carotid arteries using X-ray imaging. A contrast dye is injected to highlight the arteries, and images are taken from various angles. The procedure is often done under conscious sedation, where the patient is awake but relaxed.
What are the risks associated with a carotid angiogram?
While generally safe, a carotid angiogram carries some risks like any invasive procedure. These include bleeding or bruising at the catheter insertion site, allergic reactions to the contrast dye, and, rarely, stroke or arterial damage. The procedure is usually monitored closely to minimize these risks.
What does conscious sedation mean during a carotid angiogram?
Conscious sedation is a type of anesthesia where the patient remains awake but relaxed and pain-free. During a carotid angiogram, medications like Versed and fentanyl are commonly used to achieve this state. A trained observer monitors the patient throughout the procedure to ensure safety and comfort.
What findings can be identified in a carotid angiogram?
A carotid angiogram can identify blockages, stenosis (narrowing), or occlusions (complete blockages) in the carotid arteries. It can also reveal atherosclerotic changes, which are buildups of plaque in the arteries, and assess the patency or openness of various blood vessels supplying the brain.
Why might a carotid angiogram be needed?
A carotid angiogram is often recommended when there is suspicion of carotid artery disease, which can lead to stroke. It's used to assess the severity of blockages and guide treatment decisions, such as whether surgery or other interventions are necessary to restore adequate blood flow to the brain.
What is the recovery process after a carotid angiogram?
After a carotid angiogram, patients are usually observed in a recovery area for a few hours to ensure there are no complications. The insertion site in the groin may be sore, and patients are often advised to avoid strenuous activities for a day or two. Follow-up care includes monitoring for any signs of complications such as bleeding or swelling.
What is the role of the Mynx device in a carotid angiogram?
The Mynx device is used post-procedure to achieve hemostasis, or stop bleeding, at the catheter insertion site. It seals the artery without the need for stitches and helps reduce bleeding complications and promote faster recovery by using a specially designed sealant.