Name of the Procedure:

Transcatheter Placement of an Intravascular Stent(s) (excluding lower extremity arteries for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), also known as Endovascular Stenting or Vascular Stenting.

Summary

Transcatheter placement of an intravascular stent is a minimally invasive procedure used to place a small, metal mesh tube (stent) within blood vessels to keep them open and ensure proper blood flow. The procedure can be done through a small incision or puncture (percutaneous) or through open surgery, and it is guided by imaging technology to ensure precision.

Purpose

The procedure is used to treat blockages or narrowings in blood vessels, which can impair blood flow and lead to conditions such as aneurysms or peripheral artery disease. The goal is to eliminate blockages, reduce symptoms, improve blood flow, and prevent complications such as strokes or aneurysm rupture.

Indications

• Narrowed or blocked arteries that do not respond to medication.
• Aneurysms requiring support to prevent rupture.
• Poor blood flow causing symptoms like pain, cramping, or fatigue in the extremities or other affected areas.
• Patients who are not candidates for more invasive surgical procedures.

Preparation

• Fasting for several hours before the procedure.
• Arranging transportation for after the procedure.
• Stopping certain medications as instructed by the physician.
• Undergoing pre-procedure diagnostic tests, such as blood work or imaging studies.

Procedure Description

1. Patient Preparation: The patient is positioned on an operating or procedure table.
2. Anesthesia: Local anesthesia is applied to the insertion site; in some cases, regional or general anesthesia may be used.
3. Access: A small incision or puncture is made, typically in the groin or arm.
4. Catheter Insertion: A catheter is guided through the blood vessels to the site of the blockage or narrowing.
5. Stent Placement: The stent is delivered through the catheter and expanded at the desired location using a balloon or self-expanding mechanism.
6. Final Checks: Imaging technology, such as fluoroscopy, is used to ensure proper placement of the stent.
7. Completion: The catheter is removed, and pressure is applied to the access site to prevent bleeding.

Duration

The procedure typically takes between 1 to 3 hours, depending on complexity.

Setting

Usually performed in a hospital's catheterization lab (cath lab) or an outpatient surgical center.

Personnel

• Interventional radiologist or vascular surgeon
• Nurses
• Radiology technician
• Anesthesiologist (if general or regional anesthesia is used)

Risks and Complications

• Bleeding or infection at the access site
• Blood vessel damage
• Allergic reaction to contrast dye
• Blood clot formation
• Stent migration or blockage
• Rare risks include stroke, heart attack, or death

Benefits

• Improved blood flow
• Relief from symptoms such as pain and cramping
• Reduced risk of future vascular complications
• Minimally invasive with a quicker recovery compared to open surgery

Recovery

• Monitoring in a recovery area for several hours post-procedure
• Instructions on wound care and activity restrictions
• Possible temporary use of medications to prevent blood clots
• Follow-up appointments to monitor stent function and overall recovery
• Most patients return to normal activities within a week

Alternatives

• Medication management with blood thinners or antiplatelet drugs
• Balloon angioplasty without stent placement
• Open surgical procedures such as bypass surgery
• Pros and cons should be discussed with a healthcare provider to determine the best option

Patient Experience

• Mild discomfort at the insertion site
• Possible sensation of pressure or warmth during stent placement
• Pain management with prescribed medications as needed
• Instructions provided for home care to ensure comfortable recovery