Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection
CPT4 code
Name of the Procedure:
Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection.
Summary
This procedure involves using a catheter to place a small wire mesh tube (stent) in the carotid artery in the neck (cervical carotid artery) to keep it open. A balloon (angioplasty) may be used to widen the artery, and specialized protection devices are used to prevent clots from moving to the brain during the procedure.
Purpose
Medical Condition:
- Carotid artery stenosis (narrowing of the carotid artery) ##### Goals:
- To restore proper blood flow to the brain
- To reduce the risk of stroke by preventing artery blockage
Indications
- Symptoms of stroke or transient ischemic attack (TIA)
- Significant narrowing of the cervical carotid artery seen on imaging
- High risk for traditional surgical endarterectomy due to other medical conditions
Preparation
- Fasting for 6-8 hours before the procedure
- Adjustment or temporary discontinuation of certain medications, such as blood thinners
- Diagnostic tests: carotid ultrasound, CT angiography, or MR angiography
Procedure Description
- The patient is given local anesthesia at the catheter insertion site and possibly mild sedation.
- A small incision is made, usually in the groin.
- A catheter is inserted and guided through the blood vessels to the carotid artery.
- Contrast dye is injected to visualize the artery and the narrowing.
- A balloon catheter may be inflated to widen the artery.
- A stent is placed to keep the artery open.
- Distal embolic protection devices (like a small filter) are used to catch any debris during the procedure.
- The catheter and other devices are removed, and the incision is closed.
Duration
Typically 1 to 2 hours.
Setting
Performed in a hospital setting, usually in a specialized catheterization lab (cath lab).
Personnel
- Interventional radiologist or vascular surgeon
- Registered nurses
- Radiologic technologist
- Anesthesiologist or nurse anesthetist (if sedation is used)
Risks and Complications
Common:
- Bruising or hematoma at the incision site
- Mild bleeding ##### Rare:
- Stroke during or after the procedure
- Artery damage
- Infection at the insertion site
- Allergic reaction to contrast dye
Benefits
- Significantly reduces the risk of stroke
- Minimally invasive compared to open surgery
- Generally quicker recovery time
Recovery
- Monitoring in the hospital for several hours to a day
- Avoid strenuous activities for at least a week
- Follow-up appointments for imaging to ensure the stent is functioning properly
- Lifelong use of anti-platelet medication to prevent clotting
Alternatives
- Carotid endarterectomy: surgical removal of plaque
- Pros: Direct removal of plaque
- Cons: More invasive, longer recovery time
- Medical management: medications and lifestyle changes
- Pros: Non-invasive
- Cons: May not be sufficient for severe stenosis
Patient Experience
During the procedure, the patient might feel pressure but should not feel pain due to local anesthesia. Post-procedure, there could be mild discomfort at the insertion site, and some patients may experience fatigue. Pain management medications and comfort measures like rest will be provided.