Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch
CPT4 code
Name of the Procedure:
Percutaneous Transcatheter Placement of Intracoronary Stent(s) with Coronary Angioplasty; single major coronary artery or branch
Common Name: Stent Placement, Coronary Angioplasty, PCI (Percutaneous Coronary Intervention)
Summary
This procedure involves the insertion of a small wire mesh tube called a stent into a coronary artery that has been narrowed by plaque build-up. During the procedure, a small balloon is also used to widen the artery and improve blood flow to the heart.
Purpose
This procedure addresses coronary artery disease (CAD), where plaque build-up narrows the arteries that supply blood to the heart. The goal is to open up blocked arteries, improve blood flow, reduce symptoms like chest pain (angina), and prevent heart attacks.
Indications
- Symptoms such as chest pain, shortness of breath, or angina
- evidence of significant blockage in one of the major coronary arteries or its branches
- Acute coronary syndrome (such as a heart attack)
- Failure of medical therapy to control symptoms
Preparation
- Fasting for at least 6-8 hours before the procedure
- Medication adjustments: may need to stop blood thinners or specific medications as instructed
- Diagnostic tests: blood tests, electrocardiograms (EKG), and coronary angiography
Procedure Description
- An intravenous (IV) line is inserted for medications.
- Local anesthesia is applied to numb the insertion site, usually in the groin or wrist.
- A catheter is inserted into an artery and guided to the coronary artery using X-ray imaging.
- A contrast dye is injected to visualize the blockage.
- A balloon-tipped catheter is advanced to the blockage and inflated to widen the artery (angioplasty).
- A stent is placed at the site of the blockage to keep the artery open.
The catheter and balloon are removed, and the stent remains in place.
Tools: Catheter, balloon, intracoronary stent, contrast dye, X-ray equipment
Anesthesia: Local anesthesia with sedation
Duration
The procedure typically takes between 1 to 2 hours.
Setting
This procedure is performed in a hospital's cardiac catheterization laboratory.
Personnel
- Interventional cardiologist
- Cardiac nurses
- Radiologic technologists
- Anesthesiologist or sedation nurse
Risks and Complications
- Bleeding at the catheter insertion site
- Blood vessel damage
- Allergic reaction to contrast dye
- Heart attack or stroke
- Restenosis (re-narrowing of the artery)
- Infection
- Rarely, kidney damage from the dye
Benefits
- Reduced chest pain and other symptoms of CAD
- Improved blood flow to the heart
- Lower risk of heart attack
- Short recovery time compared to open-heart surgery
- Improved quality of life
Recovery
- Monitoring in a recovery area for several hours
- Hospital stay usually overnight
- Instructions for medication, including antiplatelet drugs to prevent stent thrombosis
- Avoid strenuous activity for a few days
- Follow-up appointments to monitor progress and manage any complications
Alternatives
- Medication management: antianginal drugs, statins, anticoagulants
- Coronary artery bypass grafting (CABG) surgery
- Enhanced external counterpulsation (EECP)
- Lifestyle changes: diet, exercise, smoking cessation
Patient Experience
During the procedure, the patient may feel pressure or mild discomfort when the balloon is inflated. Post-procedure, the insertion site might be sore, and there may be some bruising. Pain is usually managed with over-the-counter pain relievers or prescribed medication. Patients can typically resume normal activities within a few days, following their healthcare provider's instructions for a successful recovery.