DATE OF PROCEDURE: None
DESCRIPTION OF PROCEDURE: This is a cerebral angiogram and pipeline embolization of a … aneurysm.
OPERATOR: Nasser Razack, M.D. J.D.
MATERIALS: 9 Fr sheath, 8 French BMX 96/Zoom 88/6 Fr Benchmark (guide catheter), 6 French Sophia (intermediate/aspiration catheter), Phenom (microcatheter), Synchro2 Soft .014/Aristotle .018 (microwire), 8Fr/6 Fr Angioseal (vascular closure device), 5 Fr Vertebral/JB2 (diagnostic catheter), .035 Bentson guidewire, .035 Terumo glidewire, micropuncture set. A ? mm x ? mm pipeline device was used.
GENERAL ANESTHESIA: Pre-procedure evaluation confirmed that the patient was an appropriate candidate for general anesthesia. Adequate anesthesia was maintained during the entire procedure by the anesthesia team. Vital signs and pulse oximetry were monitored and recorded by the anesthetist throughout the procedure and the recovery period. The flow sheet was placed in the medical record including the medications and dosages used. No immediate sedation related complications were noted.
PROCEDURE: After explaining the risks, benefits, and alternatives of procedure, informed written consent was obtained from the patient. Risks include but are not limited to infection, hemorrhage, groin hematoma, retroperitoneal hemorrhage, reaction to contrast, renal injury, vascular injury, intracranial vascular injury, hemorrhage, aneurysm rupture, device thrombosis, stroke, severe stroke and death. Subsequently, the patient was placed supine on the angiographic table. The patient’s right groin was prepped and draped in usual sterile fashion. Local anesthetic was applied. Utilizing a single-wall micropuncture technique, access to the femoral artery was obtained. Subsequently, a 6/9 French short arterial sheath was placed. The 5-French vertebral catheter was used for selective catheterization of the right internal carotid artery, left internal carotid artery, right vertebral artery and left vertebral artery.
Digital subtraction angiography was performed centered over the head. In addition, 3-dimensional rotational angiogram of the left internal carotid artery was also obtained. This data was sent to the Leonardo workstation for further evaluation. At the end of the procedure, the sheath was removed and hemostasis was obtained with a 6/8 Fr Angioseal vascular closure device.
FINDINGS:
Left internal carotid artery: The origin of the left internal carotid artery is without significant stenosis. Normal antegrade flow of contrast is identified in all four segments of the left internal carotid artery as well as the left middle cerebral artery distribution. Evaluation of the left anterior cerebral artery distribution demonstrates normal course and caliber. Intracranial transit time and venous return are normal.
VESSELS TREATED:
Left internal carotid artery:
Over a guidewire the guide catheter was advanced over a 5 French vertebral catheter utilizing roadmap assistance. Through this in a coaxial fashion, the intermediate catheter was advanced. The microcatheter and microwire were then introduced. These were advanced past the neck of the aneurysms distally into a left MCA M2 segment. Once cannulated, the pipeline device was advanced then withdrawn proximally and deployed across the neck of the aneurysm. A post-control angiogram and high magnification demonstrated excellent opposition of the pipeline device against parent vessel. A final, low magnification post-control angiogram demonstrated no significant distal emboli.
IMPRESSION:
Status post successful pipeline embolization of a … aneurysm as detailed above.