Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Percutaneous Transluminal Coronary Angioplasty (PTCA); Each Additional Branch of a Major Coronary Artery
Summary
This procedure, commonly known as PTCA, involves using a balloon catheter to open up additional branches of a major coronary artery that have become narrowed or blocked due to plaque buildup. It is performed in addition to the primary angioplasty procedure on the major coronary artery.
Purpose
PTCA aims to improve blood flow to the heart muscle by widening the artery. This can help relieve symptoms of coronary artery disease such as chest pain and can prevent heart attacks. The goal is to restore adequate blood flow to the branches of the main coronary artery to ensure the heart functions properly.
Indications
- Symptoms of coronary artery disease, such as angina (chest pain), shortness of breath, or fatigue
- Blockages identified in the coronary arteries via diagnostic tests like angiography
- Patients who have experienced a heart attack
- Patients who have not responded to medical therapy for coronary artery disease
Preparation
- Fasting for at least 6-8 hours before the procedure
- Possible adjustments to current medications, especially anticoagulants
- Pre-procedure blood tests and imaging (e.g., electrocardiogram, echocardiogram, or coronary angiography)
- Informing the doctor of allergies, especially to contrast dye
Procedure Description
- Initial Angiography: A catheter is inserted through the skin in the groin or wrist and guided to the coronary arteries.
- Primary Angioplasty: A balloon catheter is positioned and inflated at the site of the primary blockage to widen the artery.
- Branch Angioplasty: For each additional branch, a similar balloon catheter is guided through the primary catheter to the branch arteries. The balloon is inflated to clear these additional blockages.
- Stent Placement: Stents (small wire mesh tubes) may be placed to keep the arteries open.
The procedure uses X-ray imaging and a contrast dye to guide and monitor the catheter placement.
Duration
The entire procedure, including the primary and additional branch angioplasties, typically takes between 1 and 2 hours.
Setting
PTCA is performed in a hospital catheterization laboratory (cath lab).
Personnel
- Interventional Cardiologist
- Nurses
- Radiologic Technologists
- Anesthesiologist or Sedation Specialist, if needed
Risks and Complications
- Bleeding or bruising at the catheter insertion site
- Blood vessel damage or perforation
- Allergic reaction to contrast dye
- Kidney damage due to contrast dye
- Heart attack or stroke
- Arrhythmias (irregular heartbeats)
- Need for emergency coronary artery bypass surgery
Benefits
- Relief from chest pain and other symptoms of coronary artery disease
- Improved blood flow to the heart
- Increased ability to perform physical activities without angina
- Reduced risk of heart attack
Recovery
- Monitoring in a recovery area for several hours after the procedure
- Instructions on wound care for the catheter insertion site
- Guidelines on activity restrictions and gradually resuming physical activities
- Follow-up appointments to monitor heart health and the success of the angioplasty
- Medications to prevent blood clots and manage heart conditions, as prescribed
Alternatives
- Medications to manage coronary artery disease
- Coronary artery bypass grafting (CABG) surgery
- Lifestyle changes, including diet and exercise
- Pros and cons include differences in invasiveness, recovery time, and effectiveness.
Patient Experience
- Moderate discomfort or pressure during balloon inflation
- Sedation or local anesthesia used to minimize pain
- Potential mild discomfort at the catheter insertion site post-procedure
- Pain management typically includes over-the-counter medication and care instructions upon discharge.