CPT® Code 0424T

Deleted

1. Indications

The procedure is indicated for patients diagnosed with central sleep apnea (CSA), which may arise from various underlying conditions. The following factors may contribute to the occurrence of CSA:

• Cardiovascular Disease - Conditions affecting the heart and blood vessels that may impact respiratory function.
• Stroke - Neurological events that can disrupt the brain's ability to regulate breathing.
• Conditions Affecting the Neck or Brainstem - Anatomical or pathological issues that interfere with the neural pathways responsible for breathing control.
• Morbid Obesity - Excess body weight that can lead to respiratory complications, including CSA.
• Narcotic Use - The use of narcotic medications that may depress the central nervous system and impair respiratory drive.

2. Procedure

The procedure for the insertion or replacement of the neurostimulator system involves several detailed steps to ensure proper placement and functionality of the device:

• Step 1: The procedure begins with the patient being placed under conscious sedation, allowing for communication with the physician throughout the process. Access to the venous system is achieved through a small incision made in the right axillary, cephalic, or subclavian vein.
• Step 2: A sheath is inserted into the vein, and two long access wires are advanced into the vena cava to facilitate further catheterization.
• Step 3: A guide catheter is then delivered over one of the access wires into the superior vena cava and advanced into the left brachiocephalic vein (LBC), positioning the tip at the junction with the left subclavian vein.
• Step 4: Using contrast material, venous branches are identified, and an inner catheter is threaded into the guide catheter, extending beyond it to access the pericardiophrenic vein (PPV).
• Step 5: The opening of the PPV is visualized and accessed with a coronary wire while the patient is instructed to take deep breaths to aid in the advancement of the catheter.
• Step 6: The guide catheter is advanced further, and the inner catheter is removed. The stimulation lead is then loaded into the guide catheter and deployed to the target location within the PPV.
• Step 7: The sensing lead is deployed next by threading a coronary sinus right guide catheter over the second venous access wire to a location between the tracheal carina and the junction of the brachiocephalic veins.
• Step 8: The opening of the azygos vein is visualized using contrast, and a wire is advanced to the diaphragm level, again utilizing deep breaths or coughing to facilitate this process.
• Step 9: The inner catheter is advanced over the wire, followed by the guide catheter, which is then advanced to the right lateral branch of the azygos vein for the deployment of the sensing lead.
• Step 10: Once the lead placement is assessed, stimulation is measured to ensure complete contraction of the hemidiaphragm.
• Step 11: The pulse generator is connected to the implanted leads and is placed in a subcutaneous pocket created below the clavicle. The unit is secured in place with a single ligature.
• Step 12: Finally, the functionality of the neurostimulator system is checked to ensure proper operation before concluding the procedure.

3. Post-Procedure

After the procedure, patients are typically monitored for any immediate complications related to the insertion of the neurostimulator system. Recovery may involve observation for signs of infection, bleeding, or other adverse effects at the incision site. Patients may be advised on activity restrictions and follow-up appointments to assess the functionality of the neurostimulator system and to monitor for any potential complications. It is essential for patients to report any unusual symptoms or concerns to their healthcare provider during the recovery period.