CPT® Code 0269T

1. Indications

The revision or removal of a carotid sinus baroreflex activation device is indicated in the following situations:

• Mechanical Malfunction - The device may fail to operate as intended, necessitating revision or removal.
• Pain - Patients may experience discomfort or pain associated with the device, prompting the need for intervention.
• Infection - The presence of infection at the implantation site or surrounding tissues can require removal of the device.
• Extravascular Tissue Stimulation - Unintended stimulation of surrounding tissues can lead to complications, warranting revision or removal.
• Bradycardia - The device may cause an abnormal slowing of the heart rate, necessitating intervention.
• Failure to Respond to Therapy - If the device does not provide the expected therapeutic benefits in managing hypertension, revision or removal may be required.

2. Procedure

The procedure for the revision or removal of a carotid sinus baroreflex activation device involves several critical steps to ensure proper management of the device and the patient's condition.

• Step 1: Incision and Exposure - For the revision of the generator and/or leads, the surgeon begins by reopening the old incision over the subcutaneous pocket where the generator is located. This allows access to the generator and the distal aspect of the leads.
• Step 2: Checking Connections - Once the generator and leads are exposed, the connections between the leads and the impulse generator are carefully checked. If any issues are identified, the connections may be repositioned or revised as necessary to ensure proper functionality.
• Step 3: Lead Assessment - After confirming the generator is functioning correctly, the focus shifts to the leads. If it is determined that one or both leads are not delivering impulses to the carotid sinuses, the lead insertion site(s) at the carotid artery bifurcation are exposed for further evaluation.
• Step 4: Lead Revision - If needed, one or both leads are repositioned or revised to restore their functionality. This step is crucial for ensuring that the device can effectively modulate blood pressure and heart rate.
• Step 5: Programming the Device - Once the leads and generator are confirmed to be functioning properly, the optimal frequency and intensity of impulses are determined. The generator is programmed accordingly, and adjustments to the placement of the leads are made until the desired reduction in blood pressure and heart rate is achieved.
• Step 6: Closure - After successful programming, the implantable pulse generator (IPG) is placed back into the pocket, sutured to the underlying tissue, and the incision is closed securely.
• Step 7: Complete System Removal - In cases where the entire system is being removed, the pulse generator is exposed, detached from the leads, and removed. The insertion sites of the leads at the carotid bifurcations are also exposed, and the leads are carefully dissected from surrounding tissues and removed. Finally, the incisions are closed.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications related to the surgery, such as infection or excessive bleeding. Patients may require follow-up appointments to assess the effectiveness of the device if it has been revised or to ensure proper healing if the device has been removed. It is essential to provide the patient with instructions regarding wound care, activity restrictions, and signs of potential complications that should prompt immediate medical attention. The overall recovery process will vary depending on the extent of the procedure performed and the individual patient's health status.