36223 Selective catheter placement, common carotid or innominate artery, unilateral, any approach, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the e

Name of the Procedure:

Selective Catheter Placement, Common Carotid or Innominate Artery, Unilateral, with Angiography of the Ipsilateral Intracranial Carotid Circulation
Common Carotid Artery Angiography, Innominate Artery Angiography

Summary

This procedure involves placing a catheter in the common carotid or innominate artery on one side of the body to visualize the arteries and blood flow in the brain. The imaging helps doctors diagnose and plan treatment for various cerebrovascular conditions.

Purpose

The procedure is primarily performed to evaluate and diagnose abnormalities in the arteries that supply blood to the brain. The goals include detecting blockages, aneurysms, or other vascular malformations to guide appropriate treatment.

Indications

• Signs of stroke or transient ischemic attack (TIA)
• Suspected carotid artery disease
• Aneurysms or vascular malformations
• Unexplained, severe headaches or neurological symptoms
• Pre-operative evaluation for certain surgeries

Preparation

• Fasting for 6-8 hours before the procedure.
• Adjustment or discontinuation of certain medications, especially blood thinners.
• Pre-procedure blood tests to assess kidney function and clotting status.

Procedure Description

1. The patient lies on an imaging table, and an IV line is placed for medications.
2. Local anesthesia is applied at the insertion site, typically in the groin or arm.
3. A catheter is carefully inserted into the blood vessel and guided to the common carotid or innominate artery using real-time X-ray imaging.
4. Once in position, a contrast dye is injected through the catheter to visualize the blood vessels.
5. Angiographic images are taken to assess the intracranial carotid circulation.
6. The catheter is then removed, and pressure is applied to the insertion site to prevent bleeding.

Duration

The procedure typically takes 1-2 hours.

Setting

Performed in a hospital's catheterization laboratory or specialized radiology department.

Personnel

• Interventional radiologist or vascular surgeon
• Radiology technologists
• Nurses
• Anesthesiologist or sedation nurse (if sedation is required)

Risks and Complications

• Bleeding or hematoma at the catheter insertion site
• Allergic reaction to contrast dye
• Infection
• Stroke or transient ischemic attack
• Blood vessel damage
• Kidney damage from the contrast dye

Benefits

• Detailed images of the brain's blood vessels for accurate diagnosis and treatment planning.
• Minimally invasive compared to surgical exploration.
• Immediate visualization of vascular issues and potential for quick intervention.

Recovery

• Monitoring in a recovery area for several hours.
• Instructions to drink plenty of fluids to help flush out the contrast dye.
• Avoid heavy lifting or strenuous activity for 24-48 hours.
• Follow-up appointments as directed.

Alternatives

• Non-invasive imaging tests like MRI or CT angiography.
• Pros include less risk and no need for catheter insertion.
• Cons include potentially lower image resolution and less detailed vascular assessment.

Patient Experience

During the procedure, patients may feel minor discomfort or pressure at the catheter insertion site. There may be a warm sensation when the contrast dye is injected. Post-procedure, some bruising and tenderness around the insertion site are common, and pain can be managed with over-the-counter pain medications.