61635 Transcatheter placement of intravascular stent(s), intracranial (eg, atherosclerotic stenosis), including balloon angioplasty, if performed

Name of the Procedure:

Transcatheter placement of intravascular stent(s), intracranial

• Common Names: Intracranial Stenting, Intracranial Angioplasty with Stenting
• Technical Terms: Intracranial Intravascular Stenting, Balloon Angioplasty with Stent Placement for Intracranial Stenosis

Summary

Intracranial stenting is a minimally invasive procedure where a small, mesh-like tube called a stent is placed into an artery in the brain to keep it open. This procedure often includes balloon angioplasty, where a small balloon is used to widen the artery before placing the stent.

Purpose

This procedure addresses the narrowing (stenosis) of arteries in the brain caused by atherosclerosis (buildup of plaque). The goal is to improve blood flow to the brain, reducing the risk of stroke and other complications arising from restricted blood supply.

Indications

• Symptoms of transient ischemic attacks (TIAs) or minor strokes.
• Significant intracranial atherosclerotic disease (e.g., >70% stenosis).
• Patients with recurrent symptoms despite optimal medical therapy.
• Patients who are at high risk for surgery or when other treatment options have failed.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Blood tests and imaging studies (e.g., MRI, CT angiography) are often performed.
• Medications like anticoagulants or antiplatelets may need to be adjusted before the procedure.
• Consent and a detailed explanation of the procedure and risks are provided to the patient.

Procedure Description

1. The patient is sedated, and local anesthesia is applied.
2. A catheter is inserted through a small incision, usually in the groin, and guided to the site of the arterial narrowing in the brain.
3. A balloon-tipped catheter is used to perform angioplasty, inflating the balloon to widen the artery.
4. A stent is then delivered to the area and expanded to hold the artery open.
5. The catheter and balloon are removed while the stent stays in place.
6. Imaging is used throughout the procedure to guide placement and ensure success.

Duration

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

Setting

The procedure is usually performed in a hospital's catheterization laboratory (cath lab) or an interventional radiology suite.

Personnel

• Interventional Neuroradiologist or Neurosurgeon
• Nurses and Technicians specialized in interventional procedures
• Anesthesiologist or Nurse Anesthetist

Risks and Complications

• Common Risks: Bleeding at the catheter insertion site, infection, reaction to contrast dye.
• Rare Complications: Stroke, arterial rupture, stent migration, restenosis (re-narrowing of the artery).
• Management: Monitoring in a hospital setting, medications to manage blood pressure and prevent blood clots, immediate intervention if complications arise.

Benefits

• Improved blood flow to the brain.
• Reduced risk of stroke.
• Relief from symptoms associated with reduced blood supply to the brain.
• Benefits are often seen shortly after the procedure, with stabilization or improvement of symptoms.

Recovery

• Patients are typically monitored in the hospital for 1-2 days.
• Post-procedure care includes medications to prevent clotting.
• Restrictions: Avoid heavy lifting and strenuous activities for a few days.
• Follow-Up: Regular check-ups and imaging tests to monitor the stent and blood flow.

Alternatives

• Medical therapy, including antiplatelet drugs and statins.
• Lifestyle changes (e.g., diet, exercise).
• Surgical bypass, though it is more invasive and carries higher risks.
• Pros and Cons: Medical therapy is less invasive but may be less effective for severe stenosis; surgery offers a permanent solution but with higher complication risks.

Patient Experience

The patient might feel pressure or slight discomfort during catheter insertion. Post-procedure, there might be minor discomfort at the insertion site and possible headache. Pain management is provided, and most patients can return to normal activities within a week, following their healthcare provider's guidance.