Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological super
CPT4 code
Name of the Procedure:
Transcatheter placement of an intravascular stent(s) (non-lower extremity, non-carotid, non-intracranial, non-coronary)
Summary
This procedure involves placing a tiny mesh tube called a stent into a blood vessel to keep it open. The stent is delivered using a catheter, minimizing the need for invasive surgery. It is typically performed under imaging guidance for precise placement.
Purpose
The procedure is designed to treat blood vessel narrowing or blockages in areas other than the lower extremities, carotid arteries, intracranial vessels, or coronary arteries. The goal is to restore normal blood flow and prevent complications such as organ damage due to poor circulation.
Indications
Patients may need this procedure if they have:
- Blood vessel narrowing due to atherosclerosis or other diseases.
- Symptoms like pain, organ dysfunction, or risk of significant complications due to reduced blood flow.
- Conditions where non-invasive treatment methods have failed.
Preparation
Patients are usually instructed to:
- Fast before the procedure, typically for 6-8 hours.
- Adjust or discontinue certain medications, especially blood thinners, as advised by their doctor.
- Undergo diagnostic tests such as blood work, imaging studies (CT, MRI), and an angiogram for precise mapping of the affected vessels.
Procedure Description
- Patient is positioned and prepared in a sterile environment.
- Local anesthesia or sedation is administered.
- A small incision is made to access a blood vessel, typically in the groin.
- A catheter with the stent is threaded through the blood vessels to the target area under radiological guidance.
- The stent is deployed to expand the narrowed segment and hold the vessel open.
- The catheter is removed, and the incision site is closed and bandaged.
Tools Used:
- Angiographic catheters
- Guide wires
- Stent delivery system
- Imaging equipment (fluoroscopy)
Duration
The procedure typically takes 1 to 2 hours.
Setting
The procedure is usually performed in a hospital or a specialized outpatient interventional radiology suite.
Personnel
- Interventional Radiologist or Vascular Surgeon
- Nursing staff
- Radiology Technologist
- Anesthesiologist or Nurse Anesthetist (if sedation/ anesthesia is required)
Risks and Complications
Common Risks:
- Bruising or bleeding at the access site
- Infection
- Allergic reaction to contrast dye
Rare Complications:
- Blood vessel damage
- Stent migration or misplacement
- Blood clots
- Need for further surgery
Benefits
- Restores adequate blood flow
- Reduces symptoms like pain and organ dysfunction
- Minimally invasive with quicker recovery compared to open surgery
- Improved quality of life
Recovery
- Patients generally stay in the recovery area for observation for several hours and may go home the same day or the next.
- Instructions include avoiding heavy lifting and strenuous activities for several days.
- Regular follow-up appointments for imaging studies to ensure the stent is functioning correctly.
Alternatives
- Medication management (e.g., anticoagulants, vasodilators)
- Lifestyle modifications (e.g., diet, exercise)
- Traditional open surgery
- Endarterectomy
Pros and Cons of Alternatives:
- Medications and lifestyle changes are less invasive but may not be effective for severe blockages.
- Open surgery is more invasive with a longer recovery time but might be necessary for complex cases.
Patient Experience
During the Procedure:
- The patient may feel slight pressure during catheter insertion and stent deployment.
- Sedation helps to minimize discomfort and anxiety.
After the Procedure:
- Mild soreness at the incision site.
- Some bruising and minor discomfort around the access site.
- Pain management with prescribed medications and over-the-counter pain relievers.