61650 Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory

Name of the Procedure:

Endovascular Intracranial Prolonged Administration of Pharmacologic Agent(s) Other Than for Thrombolysis, Arterial, Including Catheter Placement, Diagnostic Angiography, and Imaging Guidance; Initial Vascular Territory

Summary

This procedure involves administering medication directly to a vessel in the brain over an extended period using a catheter inserted through the arteries. It also includes diagnostic imaging to guide the process.

Purpose

The procedure aims to treat various neurological conditions by delivering medication directly to the affected area in the brain. This targeted approach ensures higher concentrations of the drug at the site of interest while minimizing systemic side effects.

Indications

• Brain tumors
• Chronic pain conditions
• Severe brain infections
• Certain types of vascular malformations Patients suitable for this procedure often have not responded to standard treatments or require more precise drug delivery.

Preparation

• Patients are usually required to fast for about 6-8 hours prior.
• Adjustments to regular medications may be necessary.
• Pre-procedure imaging tests (e.g., MRI or CT scans) and blood tests may be required.

Procedure Description

1. The patient is placed under local anesthesia with sedation.
2. A catheter is introduced into an artery, often starting from the groin area.
3. Using X-ray guidance (fluoroscopy), the catheter is navigated to the brain's targeted vascular territory.
4. Initial diagnostic angiography is performed to map the vessel.
5. The pharmacologic agent is administered through the catheter over an extended period.
6. Imaging guidance ensures accurate placement and delivery throughout the procedure.

Duration

The procedure can take several hours, depending on the complexity and duration of drug administration.

Setting

The procedure is performed in a hospital, specifically in an interventional radiology suite or a specialized operating room equipped for endovascular procedures.

Personnel

• Interventional radiologist or neurointerventional surgeon
• Specialized nurses
• Anesthesiologist (if deeper sedation or general anesthesia is required)
• Technicians for imaging support

Risks and Complications

• Infection at the catheter insertion site
• Bleeding or hematoma
• Blood vessel damage
• Stroke or transient ischemic attacks (TIAs)
• Allergic reactions to the contrast material
• Neurological deficits (rare)

Benefits

• Targeted delivery of medication to the brain
• Reduced systemic side effects
• Potentially more effective treatment of the neurological condition Benefits may be realized immediately or a few hours to days after the procedure, depending on the condition treated.

Recovery

• Monitoring in a recovery room for a few hours post-procedure
• Instructions to keep the catheter insertion site clean and dry
• Activity restrictions for a day to avoid complications
• Follow-up appointments for assessment and further imaging, if necessary

Alternatives

• Oral or intravenous medication therapy
• Stereotactic surgery
• Open surgical procedures
• Each alternative has its own risks and benefits, with systemic treatments being less targeted but less invasive.

Patient Experience

• Mild discomfort at the catheter insertion site
• Possible sensation of warmth during contrast injection
• Sedation helps keep the patient comfortable; local anesthesia minimizes pain.
• Post-procedure soreness or bruising at the insertion site, managed with over-the-counter pain relievers.