DATE OF PROCEDURE: MM/DD/YYYY
PROCEDURES PERFORMED:
1. Diagnostic selective coronary cineangiography.
2. Percutaneous coronary intervention of an occluded right coronary artery.
3. Intracoronary nitroglycerin and Integrilin injection.
OPERATOR: John Doe, MD
DESCRIPTION OF PROCEDURE: The patient was transferred from an outside hospital after a diagnostic catheterization. The patient was brought to the catheterization lab in the usual fasting state. Informed consent was obtained and the patient was prepared and draped in the usual fashion.
Following this, we obtained access to the left groin and a 6 French sheath was placed. We did not obtain access to the right groin as an Angio-Seal device was placed recently. Following this, we proceeded to advance a 5 French JR4 catheter and obtained multiple images of this vessel. Following this, we advanced a 5 French JL4 catheter to the ostium of the left main coronary artery and obtained multiple images of the left system.
Subsequently, these catheters were removed and the images were reviewed and decision was made to proceed with PCI of the occluded right coronary artery. Heparin, 5000 units, was administered. Following this, we advanced a 6 French JR4 guide catheter up to the ostium of the right coronary artery. We used an Asahi 0.014 Prowater wire to cross this lesion. After the lesion was crossed, we advanced a 2.5 x 15 mm Voyager balloon and multiple inflations were performed in the mid and proximal portions. Following this, angiography revealed flow down the vessel.
There was significant thrombus in this vessel, especially in the proximal region, which was suggestive of probably an acute occlusion in this area. Subsequently, the patient received intracoronary nitroglycerin and repeat angiographic images after that showed some resolution of the thrombus.
Following this, we proceeded to advance a 3 x 33 mm Cypher drug-eluting stent into the mid and distal portion of this vessel and this was deployed at about 16 atmospheres for 30 seconds. Subsequently, we advanced a 3.5 x 28 mm Cypher drug-eluting stent into the proximal portion and this was deployed at 16 atmospheres for 30 seconds. Subsequently, angiographic images were obtained in multiple views and we determined that there was slight haziness proximal to the stent deployment; this was not thought to be due to a thrombus or dissection. Good distal flow was noted and excellent stent deployment was also noted.
The patient was stable during the procedure and had no complaints. After confirming that we were in the true lumen in the distal portion of this vessel, the patient was given Integrilin infusion per protocol for platelet inhibition. Sheath was sewn in place and the patient was subsequently transferred to the CVR for sheath removal and will be admitted for further management.
