92974 Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy (List separately in addition to code for primary procedure)

Name of the Procedure:

Transcatheter Placement of Radiation Delivery Device for Subsequent Coronary Intravascular Brachytherapy (IVB)

Summary

This procedure involves inserting a device through the blood vessels to deliver radiation internally to treat coronary artery disease. It's a minimally invasive technique performed through a catheter to directly target the affected area within the coronary arteries.

Purpose

This procedure addresses conditions such as recurrent narrowing of the coronary arteries (restenosis), particularly after an initial angioplasty or stent placement. The goal is to reduce the risk of restenosis by delivering localized radiation therapy.

Indications

• Patients experiencing restenosis after a previous coronary angioplasty or stent placement.
• Individuals with high risk of further arterial blockages.
• Unsuccessful or insufficient results from traditional angioplasty or stenting.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustment or temporary discontinuation of certain medications, particularly anticoagulants.
• Pre-procedure diagnostic tests like blood tests, ECG, and possibly imaging studies such as angiography.

Procedure Description

1. Anesthesia: Local anesthesia is applied to numb the insertion site, usually in the groin or wrist.
2. Catheter Insertion: A catheter is threaded through the blood vessels to the site of the coronary artery blockage.
3. Placement: The radiation delivery device is placed through the catheter to the targeted area.
4. Radiation Delivery: Once correctly positioned, the device delivers a controlled dose of radiation to the affected artery segment.
5. Removal: The device and catheter are carefully removed.

Tools used include specialized catheters, radiation delivery devices, and imaging equipment to guide placement. Sedation may also be used to keep the patient comfortable.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

It is usually performed in a hospital's cardiac catheterization lab.

Personnel

• Interventional Cardiologist
• Cardiac Catheterization Lab Staff
• Radiologist, if necessary
• Nurses and Technical Staff

Risks and Complications

• Potential bleeding or infection at the catheter insertion site.
• Possible coronary artery damage.
• Risk of radiation exposure, though minimal due to precise delivery.
• Rarely, allergic reactions to contrast dye used.

Benefits

• Reduction of restenosis rates.
• Minimally invasive with a shorter recovery time compared to surgical alternatives.
• Direct treatment of the affected artery segment.

Recovery

• Monitoring in a recovery area for several hours post-procedure.
• Instructions for minimal activity for the next 24-48 hours.
• Follow-up appointments to monitor progress.
• Possible prescription of antiplatelet or anticoagulant medications to prevent clotting.

Alternatives

• Repeat angioplasty or stent placement.
• Coronary artery bypass surgery.
• Drug-eluting stents. Each alternative has its own pros and cons and may be considered based on patient-specific factors.

Patient Experience

Patients may feel slight pressure during catheter insertion but should not experience significant pain. Mild discomfort at the insertion site post-procedure is possible. Pain management options and comfort measures are provided to ensure a smooth experience. Most patients can resume normal activities within a few days, following their doctor's recommendations.