37216 Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protection

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; without distal embolic protection

Summary

This medical procedure involves inserting a stent into the cervical carotid artery via a catheter to keep the artery open and improve blood flow to the brain. It is performed through a small incision (open) or a needle puncture (percutaneous) and includes angioplasty (balloon dilation) and X-ray guidance.

Purpose

The procedure addresses narrowed or blocked carotid arteries, which can reduce blood flow to the brain and increase the risk of stroke. The goal is to prevent strokes by improving blood flow through the affected artery.

Indications

• Patients with significant carotid artery stenosis (narrowing), typically more than 50-70%.
• Previous history of transient ischemic attacks (TIAs) or strokes.
• Symptoms such as dizziness, loss of coordination, or weakness on one side of the body.
• High surgical risk patients who may not be good candidates for open surgery.

Preparation

• Patients may need to fast for several hours before the procedure.
• Current medications, especially blood thinners, may need adjustment.
• Pre-op tests such as blood work, EKG, and imaging of the carotid arteries (e.g., ultrasound or CT angiography).

Procedure Description

1. The patient is given local anesthesia at the insertion site and possibly moderate sedation.
2. The doctor makes a small incision or puncture in the groin, arm, or neck to access the artery.
3. A catheter is threaded through the blood vessels to the carotid artery using X-ray guidance.
4. Angioplasty is performed to widen the narrowed segment of the artery.
5. A stent is deployed to keep the artery open.
6. Imaging is used to ensure proper placement and functionality of the stent.
7. Once confirmed, the catheter is removed and the insertion site is closed.

Duration

The procedure typically takes about 1-2 hours.

Setting

This procedure is typically performed in a hospital's catheterization lab or an interventional radiology suite.

Personnel

• Interventional Cardiologist or Vascular Surgeon
• Radiologist
• Nursing staff
• Anesthesiologist or sedation nurse, if moderate sedation is used

Risks and Complications

• Common: Bleeding or bruising at the insertion site, infection, allergic reaction to contrast dye.
• Rare: Stroke, artery damage, stent displacement, blood clots, or heart attack.

Benefits

• Reduced risk of stroke.
• Improved blood flow to the brain.
• Relief of related symptoms such as dizziness or weakness on one side of the body.
• Benefits may be noticed immediately or within a few days after the procedure.

Recovery

• Most patients can leave the hospital within 1-2 days.
• Instructions include avoiding strenuous activity and lifting heavy objects for a week.
• Follow-up appointments to monitor the stent and artery health.
• Adherence to prescribed medications, including blood thinners may be necessary.

Alternatives

• Carotid endarterectomy (surgical removal of plaque from the artery).
• Medical management with antiplatelet or cholesterol-lowering medications.
• Pros and Cons: Carotid endarterectomy is more invasive but may be more effective long-term; medical management is less invasive but may not be as effective in severe stenosis.

Patient Experience

• During the procedure: Patients may feel pressure but should not feel pain due to local anesthesia.
• After the procedure: Mild discomfort or bruising at the insertion site. Pain medication is provided if needed.
• Light activity is recommended for the first week, and most patients return to normal activities within a few days.