Thrombolysis, cerebral, by intravenous infusion
CPT4 code
Name of the Procedure:
Thrombolysis, Cerebral by Intravenous Infusion (IV Thrombolysis, IV tPA)
Summary
Intravenous thrombolysis is a medical treatment used to dissolve blood clots in the brain and restore blood flow. This procedure is often administered in emergency situations to treat ischemic stroke, where a clot blocks blood flow to parts of the brain.
Purpose
Thrombolysis treats ischemic stroke by dissolving the clot causing the stroke. The main goal is to minimize brain damage, improve recovery outcomes, and reduce the risk of disability.
Indications
- Sudden onset of stroke symptoms such as facial drooping, arm weakness, and speech difficulties.
- CT scans confirming an ischemic stroke.
- The procedure must be performed within a specific time window, typically within 4.5 hours from the onset of symptoms.
- Suitable for patients with no history of recent major surgery, severe uncontrolled hypertension, or other bleeding risks.
Preparation
- Immediate medical evaluation to confirm stroke diagnosis (e.g., CT scan).
- Blood tests to check for clotting issues and other contraindications.
- No specific patient preparation like fasting is needed as the procedure is time-sensitive.
Procedure Description
- Initial Assessment and Consent: Rapid clinical assessment and obtaining informed consent.
- Preparation of IV Line: Establishment of intravenous access.
- Administration of Medication: Infusion of a clot-dissolving medication (typically tissue plasminogen activator, tPA) over the course of an hour.
- Monitoring: Continuous monitoring of vital signs, neurological status, and possible side effects during and after infusion.
Duration
The actual infusion takes about 60 minutes. However, preparation and post-procedure monitoring may extend the total time to several hours.
Setting
Typically performed in a hospital emergency room or stroke unit with access to imaging facilities and intensive care resources.
Personnel
- Emergency physician or neurologist
- Nurses specialized in stroke care
- Radiology technician (for initial imaging)
- Possible involvement of an intensive care team
Risks and Complications
- Common Risks: Minor bleeding or bruising at the IV site.
- Rare but Serious Risks: Intracranial hemorrhage, systemic bleeding, allergic reactions.
- Complications Management: Immediate medical interventions such as reversing agents or surgical operations in case of severe bleeding.
Benefits
- Rapid dissolution of the blood clot.
- Reduced brain damage, potentially preventing long-term disability.
- Improvement of functional outcomes and quality of life.
Recovery
- Continuous monitoring for signs of hemorrhagic complications.
- Regular neurological assessments.
- Gradual recovery varies; patients might need rehabilitation therapies.
- Follow-up care with a neurologist to monitor recovery progress and manage stroke risk factors.
Alternatives
- Mechanical thrombectomy for certain patients outside the time window for IV thrombolysis or with large artery occlusion.
- Antiplatelet or anticoagulant therapy for stroke prevention.
- Each alternative has its own risk-benefit profile based on patient criteria.
Patient Experience
- Patients might feel anxious or distressed due to the emergency nature of the situation.
- Generally, pain management is not required as thrombolysis is not painful.
- Comfort measures include reassurance, close communication, and emotional support from healthcare providers.