Name of the Procedure:

Stent Placement - Non-coated/Non-covered with Delivery System (HCPCS C1876)

Summary

A stent placement procedure involves inserting a small, non-coated/non-covered metal tube, called a stent, into a narrowed or blocked blood vessel to help keep it open and ensure proper blood flow. This procedure is typically done using a delivery system which facilitates the precise placement of the stent in the affected area.

Purpose

The primary purpose of placing a non-coated/non-covered stent is to address conditions that cause narrowing or blockage of blood vessels, such as coronary artery disease or peripheral artery disease. The goal is to improve blood flow, reduce symptoms like chest pain or leg pain, and prevent complications like heart attacks or limb loss.

Indications

• Severe coronary artery disease
• Peripheral artery disease causing significant symptoms
• Recurrent blockages after angioplasty
• Specific criteria include significant narrowing visible on imaging studies and symptoms not managed by medication alone

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjustments to medications, including stopping certain blood thinners under physician guidance
• Pre-procedure diagnostics, such as blood tests, electrocardiograms (ECG), and imaging studies like angiograms to assess the extent of the blockage

Procedure Description

1. Sedation/Anesthesia: Typically, local anesthesia with mild sedation is used.
2. Access: A small incision is made, often in the groin or wrist, to access the artery.
3. Catheter Insertion: A catheter is threaded through the blood vessels to the site of the blockage.
4. Stent Deployment: The stent, mounted on a balloon catheter, is guided to the blockage site. The balloon is then inflated, expanding the stent into place.
5. Confirmation: Imaging techniques, like fluoroscopy, are used to ensure the stent is correctly positioned.
6. Completion: The catheter is removed, and pressure is applied to prevent bleeding.

Duration

The procedure typically takes 1 to 2 hours.

Setting

The stent placement procedure is usually performed in a hospital setting, specifically in a catheterization lab.

Personnel

• Interventional Cardiologist or Vascular Surgeon
• Nurses
• Radiologic Technologist
• Anesthesiologist (if deeper sedation or general anesthesia is required)

Risks and Complications

• Common Risks: Bleeding, infection, allergic reaction to contrast dye, or bruising at the incision site.
• Rare Risks: Blood vessel damage, heart attack, stroke, kidney problems from contrast dye, or stent thrombosis (clot formation in the stent).

Benefits

• Improved blood flow to the affected area
• Alleviation of symptoms such as chest pain or leg pain
• Prevention of more severe complications like heart attacks or limb loss
• Benefits often start to be realized immediately following the procedure.

Recovery

• Monitoring in the hospital for a few hours or overnight
• Instructions to avoid strenuous activities for a few days
• Medications may be prescribed to prevent blood clots
• Follow-up appointments for assessment and imaging
• Full recovery typically spans a few days to a week

Alternatives

• Medications to manage symptoms and prevent progression of disease
• Lifestyle changes including diet and exercise modifications
• Other procedures like angioplasty without stent placement or bypass surgery
• Pros and cons include less invasiveness with medications but potentially lower effectiveness compared to stenting.

Patient Experience

• During the procedure, patients might feel pressure or mild discomfort, but pain is usually minimal.
• Post-procedure, soreness at the incision site and feelings of fatigue are common.
• Pain management includes over-the-counter pain relievers, and comfort measures such as rest and ice packs may be advised.