CPT® Code 61641

Add-On Code

1. Indications

The procedure of balloon dilatation of intracranial vasospasm is indicated for the following conditions:

• Vasospasm following subarachnoid hemorrhage - This condition occurs when blood leaks into the subarachnoid space, leading to the contraction of smooth muscle in the blood vessels, which can result in reduced blood flow to the brain.

2. Procedure

The procedure involves several critical steps to ensure effective treatment of the vasospasm:

• Preparation of the access site - The skin over the catheter access site is thoroughly cleansed to reduce the risk of infection. A local anesthetic is then injected to numb the area, ensuring patient comfort during the procedure.
• Accessing the blood vessel - A small stab incision is made in the skin, and a needle is inserted into the blood vessel. This is followed by the placement of a sheath to facilitate the introduction of further instruments.
• Threading the microcatheter or guidewire - A microcatheter or neurointerventional guidewire is carefully threaded from the access artery into the carotid circulation, allowing for precise navigation to the affected intracranial artery.
• Selective catheterization - The specific intracranial artery that requires treatment is selectively catheterized by advancing an arteriography catheter over the guidewire, enabling targeted intervention.
• Diagnostic arteriography - A diagnostic arteriography is performed to evaluate the anatomy of the artery and to determine whether balloon dilatation is warranted based on the observed conditions.
• Balloon dilatation of the initial vessel - If indicated, balloon dilatation of the primary vessel is performed, as described in CPT® code 61640. This step involves obtaining additional angiograms to assess the arterial lesion and to ascertain the appropriate placement and size of the balloon.
• Preparation and placement of the balloon catheter - The balloon catheter is prepared, and a steerable micro-guidewire along with a microcatheter is advanced through the guide catheter into the intracranial arteries and across the arterial lesion. The micro-guidewire is then removed and replaced with an exchange wire to facilitate the next steps.
• Inflation of the balloon - The microcatheter is removed, and the angioplasty balloon catheter is advanced over the exchange wire and positioned across the lesion. The balloon is inflated under fluoroscopic control, effectively dilating the arterial lesion.
• Post-dilatation evaluation - Once adequate dilatation is achieved, the balloon catheter is withdrawn into the access artery but is not completely removed. The guidewire remains in place while post-procedure angiograms are obtained to check for any complications such as hyperacute thrombosis or rebound stenosis.
• Completion of the procedure - If any complications arise, additional interventional measures are initiated. After successfully dilating the arterial lesion and addressing any issues, all catheters and guidewires are removed from the patient.

3. Post-Procedure

After the balloon dilatation procedure, patients are typically monitored for any immediate complications, including signs of thrombosis or stenosis. Post-procedure angiograms are crucial for evaluating the success of the intervention and ensuring that the arterial lesion has been adequately treated. Recovery may involve observation in a clinical setting to manage any potential side effects or complications. The healthcare team will provide specific instructions regarding follow-up care and any necessary lifestyle modifications to support recovery and prevent recurrence of vasospasm.