36224 Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, includes angiography of the extracranial carotid and ce

Name of the Procedure:

Selective catheter placement, internal carotid artery, unilateral, with angiography of the ipsilateral intracranial carotid circulation and all associated radiological supervision and interpretation, including angiography of the extracranial carotid and cephalad circulation.

Summary

This procedure involves inserting a catheter into the internal carotid artery on one side of the neck to take detailed images of the blood vessels in the brain and neck. It helps doctors diagnose and treat various conditions affecting these vessels.

Purpose

Medical Condition or Problem

• Detection and management of cerebrovascular diseases such as aneurysms, stenosis, and arteriovenous malformations.
• Evaluation of stroke patients.

Goals or Expected Outcomes

• Obtain clear, detailed images of the carotid and intracranial arteries.
• Assist in diagnosing vascular conditions and planning subsequent treatment.

Indications

Specific Symptoms or Conditions

• Suspected or confirmed cerebrovascular disease.
• Symptoms like severe headache, dizziness, vision changes, or stroke symptoms.
• Follow-up after previous vascular treatments or surgeries.

Patient Criteria

• Patients with signs of compromised blood flow to the brain.
• Individuals with risk factors for cerebrovascular diseases such as hypertension, smoking, diabetes, or atherosclerosis.

Preparation

• Fasting for at least 6 hours before the procedure.
• Adjusting medications as directed by the physician, especially blood thinners.
• Pre-procedure imaging tests like MRI or CT scans.
• Blood tests to check kidney function and clotting status.

Procedure Description

1. Anesthesia: Local anesthesia is applied at the catheter insertion site, typically the groin. Sedation may be provided if necessary.
2. Catheter Insertion: A small incision is made, and a catheter is introduced into the femoral artery and navigated to the internal carotid artery.
3. Angiography: Contrast dye is injected through the catheter to make the blood vessels visible on X-ray images. Angiograms of both the intracranial and extracranial carotid arteries are taken.
4. Interpretation: Radiologists analyze the images in real-time to identify any abnormalities.

Tools and Equipment

• Catheter and guidewires
• Contrast dye
• X-ray imaging equipment
• Monitoring devices for vital signs

Duration

The procedure typically lasts 1 to 2 hours, depending on complexity.

Setting

The procedure is performed in a hospital's angiography suite or interventional radiology department.

Personnel

• Interventional Radiologist or Neurointerventionalist
• Radiology Technologist
• Nursing staff
• Anesthesia provider, if necessary

Risks and Complications

Common Risks

• Bruising or bleeding at the catheter insertion site.
• Allergic reaction to contrast dye.

Rare Complications

• Stroke or transient ischemic attack (TIA).
• Artery damage or dissection.
• Infection at the insertion site.

Management

• Immediate medical intervention for serious complications.
• Symptomatic treatment for minor complications.

Benefits

• Accurate diagnosis of cerebrovascular conditions.
• Precise planning for surgical or nonsurgical treatments.
• Improved patient outcomes through targeted interventions.

Recovery

• Monitoring in the recovery unit for several hours.
• Instructions to keep the affected limb immobile for a few hours to prevent bleeding.
• Avoid strenuous activities for 24-48 hours.
• Follow-up appointments to discuss results and further treatment.

Alternatives

Other Treatment Options

• Non-invasive imaging tests like MR angiography (MRA) or CT angiography (CTA).

Pros and Cons

• MRA/CTA: Less invasive, no incision needed, but may not be as detailed for certain conditions.
• Patients with compromised kidney function may not be suitable for alternative imaging involving contrast dye.

Patient Experience

During the Procedure

• Sensation of pressure or mild discomfort at the insertion site.
• Warm feeling as the contrast dye is injected.

After the Procedure

• Mild soreness or bruising at the insertion site.
• Monitoring for any immediate complications.
• Pain management with over-the-counter pain relievers as needed.

Pain and discomfort are generally minimal and manageable, ensuring a relatively smooth recovery process.