The doctor reported:
36200
36222x2
36224x2
36225x2
36226x2
36227x2
I'm getting:
36224, 50
36226, 50
36227, 50
This is the report:
**Final Report**
ICD Codes / Adm.Diagnosis: / SDH Subarachnoid bleed (HCC)
Examination: XA CAROTID/CRBRL BIL W CATH - - May 15 2015 7:37PM
Accession No:
Reason: SAH
REPORT:
CLINICAL INDICATION: Subarachnoid hemorrhage.
OPERATORS:
COMPLICATIONS: None.
CONSCIOUS SEDATION: Pre-procedure evaluation confirmed that the patient was
an appropriate candidate for conscious sedation. Adequate sedation was
maintained during the entire procedure by the nurse. Vital signs, pulse
oximetry, and response to verbal commands were monitored and recorded by
the nurse throughout the procedure and the recovery period. The flow sheet
was placed in the medical record including the medications and dosages used.
The patient returned to baseline neurologic and physiologic status prior to
leaving the department. No immediate sedation related complications were
noted.
PROCEDURE: The risks, benefits, and alternatives to the procedure were
explained to the patient and the family, and written informed consent was
obtained. The patient was placed supine on the angiographic table, and the
right groin was prepped and draped in the usual sterile manner. The skin
and subcutaneous tissues were anesthetized with local anesthesia. Using a
5F micropuncture set the right common femoral artery was punctured and
cannulated and a 5 French arterial sheath was placed over a guidewire. The
sheath was attached to continuous heparinized saline flush. A 5F diagnostic
catheter was placed through the sheath and advanced over a Terumo guidewire
into the aortic arch.
Selective catheterization of the following blood vessels was performed (see
below). At the end of the procedure, hemostasis was achieved.
The sheath was pulled down into the right external iliac artery, and an RAO
and lateral angiogram of the right iliofemoral arterial system was
performed. After verifying that the sheath entered in an appropriate place,
the sheath was exchanged in a sterile fashion for a Mynx closure device, and
hemostasis was achieved without difficulty.
DIAGNOSTIC ARTERIOGRAPHY AND SUPERVISION AND INTERPRETATION OF DIAGNOSTIC
ARTERIOGRAMS:
RIGHT COMMON CAROTID ARTERY: The catheter was used to select the right
common carotid artery. DSA in the AP and lateral views of the cervical
region were performed. The distal common, proximal internal, and imaged
external carotid arteries are normal in caliber and contour. The carotid
bifurcation is widely patent.
RIGHT INTERNAL CAROTID ARTERY: The catheter was advanced into the right
internal carotid artery. DSA in the AP, lateral, and oblique views of the
intracranial circulation were performed. The intracranial segments of the
right internal carotid artery are normal in contour and caliber. The
ophthalmic artery is widely patent. There is a prominent posterior
communicating artery, with robust arterial supply to the right posterior
cerebral artery territory. The right posterior cerebral artery and its
branches are normal in caliber and contour. Note reflux down a hypoplastic
right P1 segment. The middle cerebral artery and its branch vessels are
normal in caliber and contour. The A1 segment of the right anterior cerebral
artery is absent, with no opacification of the anterior cerebral artery
territory from this injection. No evidence of aneurysm, vascular
malformation, or arteriovenous shunting. Dynamic imaging demonstrates a
normal capillary phase. The intracranial venous structures opacify
appropriately and appear patent.
RIGHT EXTERNAL CAROTID ARTERY: The catheter was advanced into the right
external carotid artery. DSA in the AP and lateral views of the extracranial
circulation was performed. The imaged branches of the external carotid
artery are normal in caliber and branching pattern. No arteriovenous
shunting.
RIGHT SUBCLAVIAN ARTERY: The catheter was advanced into the right subclavian
artery. DSA imaging was performed in the AP and lateral projections, with
imaging over the cervical region. The right subclavian artery is normal in
caliber and contour. The right vertebral artery is widely patent at its
origin and normal in caliber throughout its cervical course. The
thyrocervical and costocervical trunks are widely patent. The internal
mammary artery is widely patent at its origin.
RIGHT VERTEBRAL ARTERY: The catheter was advanced into right vertebral
artery. DSA in the AP and lateral views of the intracranial circulation
were performed. The intracranial segment of the right vertebral artery is
normal in contour and caliber. The right PICA is widely patent. The basilar
artery is normal in caliber and contour. The vertebrobasilar branch vessels
are normal in caliber and contour. The P1 segment of the right posterior
cerebral artery is hypoplastic, with flash filling of the right posterior
cerebral artery territory. The left posterior cerebral artery and its branch
vessels are normal in caliber and contour. No evidence of aneurysm, vascular
malformation, or arteriovenous shunting. Dynamic imaging demonstrates a
normal capillary phase. The intracranial venous structures opacified
appropriately and appear patent.
LEFT COMMON CAROTID ARTERY: The catheter was used to select the left common
carotid artery. DSA in the AP and lateral views of the cervical region were
performed. The distal common, proximal internal, and imaged external carotid
arteries are normal in caliber and contour. The carotid bifurcation is
widely patent.
LEFT INTERNAL CAROTID ARTERY: The catheter was advanced into the left
internal carotid artery. DSA in the AP, lateral, and oblique views of the
intracranial circulation were performed. The intracranial segments of the
left internal carotid artery are normal in contour and caliber. The middle
cerebral artery and its branch vessels are normal in caliber and contour.
The anterior cerebral artery and its branch vessels are normal in caliber
and contour. The anterior communicating artery appears normal, with no
evidence of aneurysm. There is robust filling of the right A2 and distal
anterior cerebral artery segments across anterior communicating artery, with
normal caliber and branching pattern. No evidence of aneurysm, vascular
malformation, or arteriovenous shunting. Dynamic imaging demonstrates a
normal capillary phase. The intracranial venous structures opacify
appropriately and appear patent.
LEFT EXTERNAL CAROTID ARTERY: The catheter was advanced into the left
external carotid artery. DSA in the AP and lateral views of the extracranial
circulation was performed. The imaged branches of the external carotid
artery are normal in caliber and branching pattern. No arteriovenous
shunting.
LEFT SUBCLAVIAN ARTERY: The catheter was advanced into the left subclavian
artery. DSA imaging was performed in the AP and lateral projections, with
imaging over the cervical region. There is a focal eccentric stenosis of the
subclavian artery, measuring 50%. The remainder of the subclavian artery is
normal in caliber and contour. The left vertebral artery is widely patent at
its origin and normal in caliber throughout its cervical course. The
thyrocervical and costocervical trunks are widely patent. The internal
mammary artery is widely patent at its origin.
LEFT VERTEBRAL ARTERY: The catheter was advanced into left vertebral
artery. DSA in the AP, lateral, and oblique views of the intracranial
circulation were performed. The intracranial left vertebral artery is normal
in contour and caliber. The left PICA is widely patent. The basilar artery
is normal in caliber and contour. The vertebrobasilar branch vessels are
normal in caliber and contour. The P1 segment of the right posterior
cerebral artery is hypoplastic, with flash filling of the right posterior
cerebral artery territory. The left posterior cerebral artery and its branch
vessels are normal in caliber and contour. No evidence of aneurysm, vascular
malformation, or arteriovenous shunting. Dynamic imaging demonstrates a
normal capillary phase. The intracranial venous structures opacified
appropriately and appear patent.
RIGHT EXTERNAL ILIAC ARTERY: The catheter was removed, and the sheath was
left in place. DSA in the lateral and RAO views of the right iliofemoral
arterial system were performed. The arteries of the iliofemoral system are
normal in caliber. Imaging demonstrates appropriate positioning of the
arteriotomy for closure device placement.
IMPRESSION:
1. No evidence of aneurysm, arteriovenous confirmation, or dural
arteriovenous fistula.
2. No evidence of cerebral vasculitis or cortical vein thrombosis.
neuro interventional new to me
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