CPT® Code 0267T

1. Indications

The implantation or replacement of a carotid sinus baroreflex activation device is indicated for patients with refractory hypertension, which is characterized by high blood pressure that remains uncontrolled despite the use of multiple antihypertensive medications. This condition often requires advanced therapeutic interventions to manage cardiovascular risks effectively.

• Refractory Hypertension Patients who have not achieved adequate blood pressure control with standard pharmacological treatments.

2. Procedure

The procedure for the implantation or replacement of the carotid sinus baroreflex activation device involves several critical steps to ensure proper placement and functionality of the device.

• Step 1: Incision and Exposure An incision is made over the carotid bifurcation on one side of the neck to access the common carotid artery. Care is taken to expose the artery while protecting the surrounding neurovascular structures.
• Step 2: Identification of the Vagus Nerve The vagus nerve is identified during the procedure and is carefully protected to prevent any damage that could affect its function.
• Step 3: Mobilization of the Carotid Bifurcation The carotid artery bifurcation is mobilized circumferentially, ensuring that the neurovascular bundle within the bifurcation remains undisturbed.
• Step 4: Electrode Placement The first electrode is positioned on the bifurcation in the area of the carotid sinus. This electrode is then connected to the impulse generator for testing.
• Step 5: Testing and Repositioning The electrode is tested for hemodynamic response, and if necessary, it is repositioned to achieve optimal results. Once satisfactory response is obtained, the electrode is sutured in place.
• Step 6: Repetition on Contralateral Side The procedure is then repeated on the contralateral side to ensure bilateral functionality of the device.
• Step 7: Tunneling of Leads The leads from the electrodes are tunneled to the infraclavicular region, where a subcutaneous pocket for the impulse generator is created.
• Step 8: Creation of Subcutaneous Pocket An incision is made in the skin, and a subcutaneous pocket is fashioned to accommodate the impulse generator.
• Step 9: Connection and Testing of Impulse Generator The leads are connected to the impulse generator, which is then tested to ensure proper functionality.
• Step 10: Programming the Generator The optimal frequency and intensity of electrical impulses are determined, and the generator is programmed accordingly.
• Step 11: Final Placement and Closure After confirming that the leads and impulse generator are functioning correctly and achieving the desired reduction in blood pressure and heart rate, the impulse generator is placed into the pocket, sutured to the underlying tissue, and the pocket is closed.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications and ensuring that the device is functioning as intended. Patients may require follow-up visits to assess the effectiveness of the device in managing blood pressure and to make any necessary adjustments to the programming of the impulse generator. Additionally, patients should be educated on signs of potential complications, such as infection at the incision site or issues with the device itself, and instructed on activity restrictions during the initial recovery period.