CPT® Code 0645T

1. Indications

The transcatheter implantation of a coronary sinus reduction device (CPT® Code 0645T) is indicated for patients experiencing refractory angina, particularly in the context of obstructive coronary artery disease. This condition is characterized by persistent chest pain or discomfort that does not adequately respond to standard medical therapies, including medications and lifestyle modifications. The procedure aims to alleviate symptoms by improving myocardial blood flow through the strategic narrowing of the coronary sinus.

• Refractory Angina Persistent chest pain that does not respond to conventional treatments.
• Obstructive Coronary Artery Disease A condition where coronary arteries are narrowed or blocked, leading to reduced blood flow to the heart muscle.

2. Procedure

The procedure for the transcatheter implantation of a coronary sinus reduction device involves several critical steps to ensure successful placement and function of the device. Initially, vascular access is obtained through the right internal jugular vein, which allows for the introduction of catheters into the venous system. A guidewire is then placed to facilitate the advancement of a 6 French diagnostic catheter into the right atrium, where central venous pressure is recorded to assess hemodynamics. Following this, the catheter is selectively positioned into the coronary sinus, and contrast material is injected to visualize the anatomy through angiography. This imaging step is essential for evaluating the vessel structure and planning the subsequent steps. Once the anatomy is confirmed, a 9 French delivery catheter is exchanged for the diagnostic catheter over the guidewire. This delivery catheter is carefully positioned distally within the coronary sinus, and its tip is advanced to the predetermined implantation site. With the device in place, the catheter is retracted, allowing the balloon to inflate and expand the coronary sinus reducer, securing it within the vessel. After the device is deployed, the balloon is deflated, and the catheter is removed. To ensure the device is correctly positioned and to check for any complications such as migration or perforation, a follow-up angiogram is performed. This comprehensive approach ensures that the device is optimally placed to achieve the desired therapeutic effect.

• Step 1: Obtain vascular access through the right internal jugular vein.
• Step 2: Place a guidewire and advance a 6 French diagnostic catheter into the right atrium, recording central venous pressure.
• Step 3: Selectively position the catheter into the coronary sinus and inject contrast for angiography.
• Step 4: Exchange the diagnostic catheter for a 9 French delivery catheter over the guidewire, positioning it distally in the coronary sinus.
• Step 5: Advance the catheter tip to the target implantation site and retract the catheter to allow balloon inflation and device expansion.
• Step 6: Deflate the balloon and remove the catheter, followed by a follow-up angiogram to verify device position and assess for complications.

3. Post-Procedure

After the transcatheter implantation of the coronary sinus reduction device, patients are typically placed on dual antiplatelet therapy, which commonly includes medications such as aspirin and clopidogrel. This regimen is crucial for preventing thrombotic events at the implantation site and ensuring the long-term success of the device. Patients are monitored for any immediate complications and are advised on follow-up care to assess the effectiveness of the procedure and manage any ongoing symptoms. The expected recovery period may vary, but patients are generally encouraged to engage in gradual physical activity as tolerated, while adhering to the prescribed medication regimen.