CLINICAL HISTORY:
COMPARISON: No previous study available for comparison.
ANESTHESIA: 45 minutes conscious sedation using 1illigrams of IV Versed and 50 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: 18 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. Extensive discussion of the risks and benefits including risk of massive stroke and death and vessel injuries were discussed. Patient and family had no further questions and agreed to proceed.
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.
An arch aortography was not performed due to the clear anatomy visualization of the recent CT angiogram of the neck and chest. This was used as a roadmap.
Using a 5 French glide vertebral catheter and a soft tipped Glidewire, the right common carotid artery was subselected and digital subtraction angiogram was performed after double flushing each time. Standard technique for neural intervention was performed.
After confirming the lack of unstable plaque formation in the common and internal carotid arteries, the catheter was carefully placed into the proximal aspect of the external carotid artery and repeat digital subtraction angiogram was performed in multiple projections. This delineated to vascular supplies, one by tiny 1 mm vessel, too small to access even with the microcatheter system. Attention was given to the larger more dominant vessel more superiorly and using a microcatheter system, this single dominant feeding vessel was super selected and repeat angiogram was performed, confirming the lack of any fistula connection to the internal carotid artery circulation or vital structures.
At this time, it was decided to place 2 microcoils ranging from to millimeter and 3 mm diameter sizes, using detachable coils to minimize malposition of the target coils. Repeat angiogram shows no further flow to the tumor vessels. There is optimal preservation of normal branch arteries to the face and neck.
Catheter was then pulled and the sheath was removed after deployment of the hemostatic device, the Mynx system. Patient’s femoral and pedal pulses were normal) preserved after the procedure.
Patient suffered no immediate procedural or sedation complications. Patient’s neurologic status was completely stable with no focal neurologic deficits or change.
IMPRESSION:
Successful pre-operative platinum coil micro-embolization of the right carotid body tumor without immediate procedural or sedation complications. No further blood flow to the carotid mass was seen.