Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and
CPT4 code
Name of the Procedure:
Transcatheter Placement of Intravascular Stent(s), Intrathoracic Common Carotid Artery or Innominate Artery by Retrograde Treatment, Open Ipsilateral Cervical Carotid Artery Exposure, Including Angioplasty and Radiological Supervision
Summary
This procedure involves placing a stent (a small mesh tube) in the intrathoracic common carotid or innominate artery. It is done via a catheter inserted through the neck to help keep the artery open and restore normal blood flow. The procedure may involve angioplasty, which uses a balloon to widen the artery, and relies on imaging guidance to ensure precision.
Purpose
The procedure is designed to treat blockages or narrowing in the intrathoracic common carotid or innominate artery, which can restrict blood flow to the brain and head. The goal is to prevent stroke or other complications by ensuring sufficient blood flow through these critical arteries.
Indications
- Symptoms of cerebral ischemia such as dizziness, transient ischemic attacks (TIAs), or stroke.
- Significant narrowing or blockage (stenosis) of the intrathoracic common carotid or innominate artery.
- Conditions such as atherosclerosis that cause arterial narrowing.
Preparation
- Patients may need to fast for several hours prior.
- Blood thinners or other medications might need to be adjusted.
- Pre-procedure tests like blood work, EKG, and imaging studies (e.g., CT scan, ultrasound).
Procedure Description
- The patient is administered local anesthesia and sedatives.
- An incision is made in the neck to expose the carotid artery.
- A catheter is inserted into the artery and advanced to the site of the blockage.
- Angioplasty may be performed, where a balloon is inflated to widen the artery.
- A stent is placed to keep the artery open.
- Radiological imaging (typically fluoroscopy) is used for real-time guidance.
- The catheter is removed, and the incision is closed.
Duration
Typically takes about 1 to 2 hours.
Setting
Performed in a hospital setting, usually in a specialized catheterization lab or operating room.
Personnel
- Vascular surgeon or interventional radiologist
- Surgical nurses
- Anesthesiologist
- Radiologic technologists
Risks and Complications
- Common risks: bleeding, infection, and bruising at the catheter insertion site.
- Rare risks: allergic reaction to contrast dye, artery damage, stroke, or heart attack.
- Management: Close monitoring and immediate intervention if complications arise.
Benefits
- Reduced risk of stroke.
- Improved blood flow to the brain and head.
- Relief from symptoms of restricted blood flow.
Recovery
- Initial recovery in the hospital under observation for monitoring.
- Instructions on wound care, activity restrictions, and medications.
- Follow-up appointments to assess the success of the procedure and ongoing arterial health.
Alternatives
- Carotid endarterectomy (surgical removal of plaque).
- Medication management (anticoagulants, cholesterol-lowering drugs).
- Lifestyle changes (diet, exercise).
Patient Experience
- Mild discomfort or pressure during the procedure.
- Post-procedure pain managed with medications.
- Some activity restrictions while the incision heals.
- Regular follow-up for monitoring and prevention of re-narrowing (restenosis).