Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed
CPT4 code
Name of the Procedure:
Selective Catheter Placement, Vertebral Artery, Unilateral with Angiography
Summary
This procedure involves placing a catheter into one of the vertebral arteries to create detailed images (angiograms) of the blood vessels in the head and neck. These images help doctors diagnose and treat certain conditions affecting the blood flow to the brain.
Purpose
This procedure is typically performed to identify or evaluate abnormalities in the vertebral artery or other blood vessels in the brain and neck. Conditions such as aneurysms, blockages, or arteriovenous malformations can be diagnosed and sometimes treated with this procedure.
Indications
- Symptoms of stroke or transient ischemic attack (TIA)
- Persistent headaches
- Dizziness or vertigo
- Neurological deficits suggesting vascular issues
- Suspected aneurysms or other vascular abnormalities
Preparation
- Fasting for 6-8 hours before the procedure
- Adjusting or stopping certain medications as advised by your doctor
- Diagnostic tests like blood work or a preliminary MRI/CT scan
Procedure Description
- The patient is positioned on an angiography table, and a local anesthetic is applied to the insertion site.
- A small incision is made, usually in the groin area, to access a major blood vessel.
- A catheter is carefully advanced through the blood vessels to the targeted vertebral artery.
- Contrast dye is injected through the catheter to visualize blood flow under X-ray imaging.
- Multiple images of the vertebral circulation are taken, including the cervicocerebral arch if necessary.
- The catheter is removed, and the incision site is closed and bandaged.
Duration
The procedure usually takes around 1-2 hours.
Setting
This procedure is typically performed in a hospital’s radiology or interventional radiology department.
Personnel
- Interventional radiologist or neuro-radiologist
- Radiologic technologists
- Registered nurse
- Anesthesiologist (if sedation is used)
Risks and Complications
- Common: Bruising or minor bleeding at the incision site, headache
- Rare: Stroke, allergic reaction to contrast dye, blood vessel damage, infection
Benefits
The significant benefit is the detailed imaging of blood vessels in the brain, which helps in diagnosing and potentially treating vascular abnormalities. Results are often available immediately.
Recovery
- The patient will need to lie flat for a few hours after the procedure to prevent bleeding.
- Instructions will include avoiding strenuous activities for a day or two and monitoring the incision site.
- Follow-up appointments for results and further treatment planning.
Alternatives
- Non-invasive imaging tests like MRI or CT angiography
- Standard catheter angiography if complications from selective catheter placement are a concern
- Medical management of the underlying condition
Patient Experience
During the procedure, patients might feel a slight pressure at the catheter insertion site but usually no severe pain. Some might experience a warm sensation when the contrast dye is injected. Post-procedure, patients may feel mild discomfort or bruising at the incision site. Pain management includes over-the-counter pain relievers.
Pain is generally well-controlled, and discomfort should be minimal in most cases.