Percutaneous Transcatheter Placement of Drug-Eluting Intracoronary Stent(s) (C9600)

Name of the Procedure:

Common Names:

• Stent Placement
• Angioplasty with Stent

Technical/Medical Term:

• Percutaneous Transcatheter Placement of Drug-Eluting Intracoronary Stent(s), with Coronary Angioplasty when Performed; Single Major Coronary Artery or Branch (C9600)

Summary

The procedure involves the insertion of a tiny drug-eluting stent via a catheter into a narrowed or blocked coronary artery. This is often done following coronary angioplasty, where a balloon is inflated to open up the artery. The stent helps keep the artery open and releases medication to prevent re-blockage.

Purpose

This procedure is typically performed to:

• Improve blood flow to the heart.
• Relieve symptoms of coronary artery disease such as chest pain (angina).
• Reduce the risk of a heart attack.

Indications

The procedure is indicated for patients with:

• Significant narrowing or blockage in a major coronary artery.
• Angina (chest pain) not adequately controlled by medication.
• Acute coronary syndromes (e.g., heart attack or unstable angina).
• Recurrent symptoms after previous interventions.

Preparation

Patients may be instructed to:

• Fast for several hours before the procedure.
• Adjust or stop certain medications, particularly blood thinners, under doctor's guidance.
• Undergo diagnostic tests such as an ECG, blood tests, and coronary angiography.

Procedure Description

1. The patient is given local anesthesia and possibly conscious sedation.
2. A small incision is made in the groin, wrist, or arm to access a major blood vessel.
3. A catheter is threaded through the blood vessel to the coronary artery.
4. A balloon catheter is used to open up the narrowed artery (angioplasty).
5. A drug-eluting stent is placed at the site of the blockage.

6. The stent is expanded, and the balloon is deflated and removed, leaving the stent in place to keep the artery open.

   Tools and Equipment:

   • Catheter
   • Balloon catheter
   • Drug-eluting stent
   • X-ray imaging technology for guidance

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Usually performed in a hospital’s cardiac catheterization lab.

Personnel

• Interventional Cardiologist
• Nurses
• Radiologic Technologists
• Anesthesiologist or Nurse Anesthetist (if deep sedation or general anesthesia is used)

Risks and Complications

Common risks include:

• Bleeding or bruising at the catheter insertion site.
• Allergic reactions to contrast dye.

Rare complications may include:

• Blood vessel damage.
• Heart attack.
• Arrhythmias (irregular heartbeats).
• Infection.
• Stent thrombosis (blood clot in the stent).

Benefits

• Relief from angina.
• Improved blood flow to the heart muscle.
• Reduced risk of heart attack. Benefits typically begin almost immediately after the procedure.

Recovery

Patients are advised to:

• Rest and avoid strenuous activities for a few days.
• Follow medication regimens as prescribed, usually including antiplatelet drugs.
• Attend follow-up appointments. Recovery time is usually a few days to a week.

Alternatives

Other treatment options:

• Medication management.
• Coronary Artery Bypass Grafting (more invasive surgery). Each alternative has its own risks and benefits, which should be discussed with a doctor.

Patient Experience

During the procedure, patients may feel pressure but not pain at the catheter site. Post-procedure, there may be soreness at the incision site and a need for pain management. Comfort measures include pain medications and keeping the insertion site clean and dry.