37218 Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation

Name of the Procedure:

Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation.

Summary

This minimally invasive procedure involves placing a stent inside the intrathoracic common carotid artery or innominate artery to keep it open. It is done using a catheter inserted through a small incision or puncture. The procedure may also involve angioplasty and is guided by radiological imaging.

Purpose

The procedure addresses conditions causing narrowing or blockage of the common carotid artery or innominate artery, such as atherosclerosis. The primary goal is to restore adequate blood flow, reduce the risk of stroke, and alleviate symptoms related to reduced blood flow to the brain.

Indications

• Severe narrowing (stenosis) or blockage of the common carotid or innominate artery
• Symptoms of reduced blood flow to the brain, like transient ischemic attacks (TIAs) or strokes
• Patients with high risk for open surgical procedures
• Evidence of significant atherosclerotic disease despite medical therapy

Preparation

• Fasting for a certain period before the procedure (usually 8 hours)
• Stopping certain medications as advised by the doctor (e.g., blood thinners)
• Pre-procedure blood tests and imaging studies (such as ultrasound or CT angiography)
• Detailed discussion with the doctor about medical history and allergies

Procedure Description

1. The procedure begins with administering local anesthesia at the insertion site, and sedation may also be provided for comfort.
2. A small incision or puncture is made, usually in the groin or neck, to insert a catheter into the artery.
3. Using radiological imaging, the catheter is guided to the site of the blockage.
4. A balloon angioplasty may be performed to widen the artery.
5. A stent is then deployed to keep the artery open.
6. Radiological imaging ensures the correct placement of the stent.
7. The catheter is removed, and the incision or puncture site is closed.

Duration

The procedure typically takes 1 to 3 hours, depending on complexity.

Setting

This procedure is usually performed in a hospital's catheterization lab or an outpatient surgical center equipped with radiological imaging facilities.

Personnel

• Interventional radiologist or vascular surgeon
• Nurse(s)
• Radiology technician
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Common risks: bruising, bleeding at the insertion site, minor pain or discomfort
• Rare risks: infection, allergic reaction to contrast dye, blood vessel damage, stent migration, stroke, heart attack, kidney damage (from contrast dye), reaction to anesthesia

Benefits

• Improved blood flow to the brain
• Reduced risk of stroke
• Relief from symptoms associated with poor circulation
• Shorter recovery time compared to open surgery

Recovery

• Patients are usually monitored for several hours or overnight.
• Instructions may include avoiding strenuous activities for a few days and monitoring the insertion site for signs of infection.
• Follow-up appointments for imaging studies to ensure the stent remains open.
• Patients can typically resume normal activities within a week.

Alternatives

• Carotid endarterectomy (open surgery to remove plaque)
• Medications (antiplatelets, statins)
• Lifestyle modifications (diet, exercise)
• Each option varies in risk, invasiveness, and recovery time.

Patient Experience

• During the procedure: Mild discomfort from lying still, sensation of warmth from contrast dye, pressure at the insertion site.
• After the procedure: Some soreness at the insertion site, usually manageable with over-the-counter pain medication, feelings of fatigue.
• Pain management includes prescribed pain medications and instructions for care at home to ensure comfort and proper healing.