Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation (eg, middle cerebral arter
CPT4 code
Name of the Procedure:
Selective catheter placement, each intracranial branch of the internal carotid or vertebral arteries, unilateral, with angiography of the selected vessel circulation and all associated radiological supervision and interpretation. Commonly referred to as "Intracranial Angiography" or "Cerebral Angiogram".
Summary
Intracranial Angiography is a specialized imaging procedure used to visualize the blood vessels in the brain. A catheter is inserted through the arteries to inject contrast dye, which highlights the blood vessels, aiding in the diagnosis and treatment of various neurological conditions.
Purpose
This procedure is primarily used to identify and assess abnormalities in the blood vessels of the brain, such as aneurysms, arteriovenous malformations (AVMs), stenosis, and blockages. It helps in planning treatments such as surgery or endovascular interventions.
Indications
- Symptoms of a stroke or transient ischemic attack (TIA)
- Unexplained neurological symptoms (e.g., severe headache, seizures, vision changes)
- Evaluation of known vascular abnormalities (e.g., aneurysms, AVMs)
- Pre-surgical mapping of cerebral vasculature
- Follow-up after previous vascular interventions
Preparation
- Patients may be instructed to fast for several hours prior to the procedure.
- Blood tests may be required to assess kidney function and blood clotting ability.
- Patients should inform their doctor of any allergies, particularly to contrast dye, and current medications.
- Medications such as blood thinners may need to be adjusted.
Procedure Description
- A local anesthetic is applied to the groin area where the catheter will be inserted into the femoral artery.
- Under X-ray guidance, the catheter is navigated through the blood vessels to the targeted branch of the intracranial arteries.
- Contrast dye is injected through the catheter, and X-ray images are taken to visualize the cerebral circulation.
- The radiologist interprets the images to identify any abnormalities.
- Finally, the catheter is removed, and pressure is applied to the insertion site to prevent bleeding.
Duration
The entire procedure typically takes between 1 to 2 hours.
Setting
The procedure is usually performed in the radiology department of a hospital, often in a specialized angiography suite.
Personnel
- Interventional radiologist or neurosurgeon
- Radiologic technologists
- Nurses
- Anesthesiologist or sedation nurse (if sedative/anesthetic is required)
Risks and Complications
- Allergic reactions to contrast dye
- Bleeding or hematoma at the catheter insertion site
- Blood vessel damage
- Stroke or transient ischemic attack
- Infection at the puncture site
- Kidney damage due to contrast dye
Benefits
- Detailed visualization of cerebral vessels
- Assists in accurate diagnosis and treatment planning
- Minimally invasive with a relatively short recovery period
Recovery
- Patients are typically monitored for several hours post-procedure for any immediate complications.
- Instructions include drinking plenty of fluids to help flush the contrast dye from the system, and avoiding strenuous activities for 24-48 hours.
- Follow-up appointments are scheduled to discuss imaging results and next steps.
Alternatives
- Non-invasive imaging techniques such as Magnetic Resonance Angiography (MRA) or Computed Tomography Angiography (CTA).
- Each alternative has its own advantages and disadvantages in terms of detail, risk, and patient suitability.
Patient Experience
During the procedure, patients may feel a warm sensation when the contrast dye is injected. Post-procedure, there might be some discomfort at the catheter insertion site. Pain management includes over-the-counter pain relief and care instructions to ensure comfort and prevent complications.