Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additio
CPT4 code
Name of the Procedure:
Percutaneous Transluminal Revascularization of or Through Coronary Artery Bypass Graft (CABG)
Common Name(s): PCI of CABG, Coronary Stent Procedure, Angioplasty, Atherectomy
Summary
This is a minimally invasive procedure to open narrowed or blocked coronary artery bypass grafts using a combination of stents, atherectomy (plaque removal), and balloon angioplasty. If necessary, distal protection devices are used to prevent debris from entering the bloodstream during the procedure.
Purpose
The procedure aims to restore proper blood flow through previously bypassed coronary arteries that have become narrowed or blocked again. It alleviates symptoms like chest pain and improves heart function and overall quality of life.
Indications
- Recurrent chest pain (angina) despite medication
- Significant narrowing or blockage in a coronary artery bypass graft
- Reduced blood flow to the heart confirmed by stress tests or imaging
- Myocardial infarction (heart attack) due to graft blockage
Preparation
- Fasting for at least 6 hours prior to the procedure
- Stopping certain medications, such as blood thinners, as advised
- Pre-procedure diagnostic tests like ECG, blood tests, and possibly a coronary angiogram
Procedure Description
- Anesthesia: Local anesthesia with sedation or general anesthesia is administered.
- Access: A catheter is inserted through an artery in the groin or wrist.
- Navigation: The catheter is guided to the site of the blocked or narrowed graft.
- Intervention:
- Atherectomy: Plaque is cut or shaved away.
- Angioplasty: A balloon is inflated to widen the artery.
- Stenting: A stent is placed to keep the artery open.
- Distal Protection: Special devices may be deployed to capture any debris.
- Completion: The catheter is removed, and the insertion site is bandaged.
Duration
The procedure typically takes 1 to 3 hours, depending on complexity.
Setting
Performed in a hospital's cardiac catheterization lab or an outpatient surgical center specialized in cardiac care.
Personnel
- Interventional cardiologist
- Cardiac nurses
- Radiologic technologists
- Anesthesiologist or sedation specialist
Risks and Complications
- Bleeding or hematoma at the catheter site
- Infection
- Blood vessel damage
- Allergic reaction to contrast dye
- Kidney damage from contrast dye
- Restenosis (re-narrowing of the artery)
- Heart attack or stroke (rare)
- Embolism (dislodged debris causing blockage)
Benefits
- Symptom relief from chest pain or shortness of breath
- Improved heart function
- Enhanced quality of life and exercise capacity
Recovery
- Observation in a recovery area for several hours post-procedure
- Limiting strenuous activities for a few days
- Regular follow-up appointments
- Medication regimen to prevent blood clots and manage cholesterol
Alternatives
- Medication therapy (e.g., beta-blockers, nitrates, statins)
- Lifestyle changes (diet, exercise, smoking cessation)
- Repeat coronary artery bypass graft surgery (if feasible)
Pros and Cons:
- Medication: Non-invasive but less immediate relief.
- Lifestyle Changes: Essential for long-term health but may not be sufficient alone.
- CABG Surgery: Long-term solution with a longer recovery time and higher risk.
Patient Experience
- Mild discomfort during catheter insertion and manipulation.
- Post-procedural pain management with medications.
- Temporary activity restrictions and close monitoring for any signs of complications.
- Generally, patients are discharged the same day or after an overnight stay when uncomplicated.
Pain and discomfort are managed effectively with appropriate medications and patient care protocols.