Name of the Procedure:

Selective Catheter Placement, Common Carotid or Innominate Artery, Unilateral Angiography

Summary

This procedure involves the selective placement of a catheter into either the common carotid artery or the innominate artery on one side of the neck. It includes angiography, which is an imaging technique used to visualize the blood vessels in the neck's extracranial carotid circulation. The procedure is accompanied by all necessary radiological supervision and interpretation.

Purpose

This procedure is used to diagnose and evaluate conditions affecting the blood vessels in the neck, particularly the carotid arteries, which supply blood to the brain. It helps in identifying blockages, narrowing, or other vascular abnormalities that could lead to stroke or other complications.

Indications

• Symptoms of a stroke or transient ischemic attack (TIA)
• Suspected carotid artery stenosis (narrowing)
• Vascular abnormalities noted in other imaging studies
• Preoperative evaluation for carotid endarterectomy
• Unexplained dizziness or syncope (fainting)

Preparation

• Patients may be advised to fast for several hours before the procedure.
• Current medications will be reviewed, and some may need to be adjusted or temporarily discontinued, especially blood thinners.
• Pre-procedure diagnostic tests may include blood work and non-invasive imaging studies like an ultrasound or CT scan.

Procedure Description

1. The patient is positioned on an examination table, and an intravenous (IV) line is placed for medication administration.
2. Local anesthesia is administered at the insertion site, usually in the groin or neck.
3. A small incision is made, and a catheter is inserted and guided through the blood vessels to the targeted artery.
4. Contrast dye is injected through the catheter to allow the blood vessels to be visible on X-ray imaging.
5. The radiologist captures a series of images to assess the blood flow and identify any abnormalities.

6. Once the imaging is complete, the catheter is carefully removed, and pressure is applied to the insertion site to prevent bleeding.

   Duration

   The procedure typically takes about 30-60 minutes.

Setting

Performed in a hospital's radiology department or a specialized outpatient vascular center.

Personnel

• Interventional radiologist or vascular surgeon
• Radiology technicians
• Registered nurses
• Anesthesiologist (if sedation is necessary)

Risks and Complications

• Infection at the catheter insertion site
• Bleeding or bruising
• Allergic reaction to the contrast dye
• Damage to the blood vessel
• Stroke (rare)
• Kidney damage from the contrast dye (especially in patients with pre-existing kidney conditions)

Benefits

• Accurate diagnosis of vascular conditions affecting blood flow to the brain
• Helps in planning further treatment, such as surgery or angioplasty
• Can be life-saving by preventing potential strokes

Recovery

• Patients are usually monitored for a few hours post-procedure
• Instructions may include resting for the remainder of the day and avoiding strenuous activities for a short period
• Follow-up appointments may be scheduled to discuss results and further treatment

Alternatives

• Carotid ultrasound: Non-invasive but less detailed imaging
• CT angiography (CTA): Less invasive and does not require catheter placement
• Magnetic Resonance Angiography (MRA): Another non-invasive option but may not be suitable for all patients

Patient Experience

During the procedure, patients will feel little to no pain due to local anesthesia. They might experience a warm sensation when the contrast dye is injected. Post-procedure, mild discomfort or bruising at the catheter insertion site can occur, managed with over-the-counter pain relievers. Most patients can return to normal activities within a day or two, following their physician’s recommendations.