CPT® Code 0425T

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 can disrupt normal respiratory function.
• Stroke: Neurological impairments resulting from a stroke can interfere with the brain's ability to regulate breathing.
• Conditions Affecting the Neck or Brainstem: Anatomical or pathological issues in these areas can impact the signals sent to the respiratory muscles.
• Morbid Obesity: Excess body weight can lead to respiratory complications, including CSA.
• Narcotic Use: The use of narcotic medications can depress the central nervous system, affecting breathing patterns.

2. Procedure

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

• Step 1: The procedure begins with the patient receiving conscious sedation, allowing them to remain communicative during the process. Access to the right side venous system is achieved through a small incision made in the right axillary, cephalic, or subclavian vein.
• Step 2: A sheath is placed in the vein, and two long access wires are advanced into the vena cava. This step is crucial for establishing a pathway for subsequent catheter placement.
• 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 facilitate access to 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, which aids in the advancement of the wire.
• Step 6: The guide catheter is further advanced, and the inner catheter is removed. The stimulation lead is then loaded into the guide catheter and deployed to the targeted location within the PPV.
• Step 7: The sensing lead is deployed next. This involves threading a coronary sinus right guide catheter over the second venous access wire to a position 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 step.
• Step 9: An 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: After lead placement, the effectiveness of the stimulation is assessed 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 unit is checked to confirm that it operates correctly.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications and ensuring that the neurostimulator system is functioning as intended. Patients may be advised on activity restrictions and follow-up appointments to assess the effectiveness of the treatment. It is essential to provide education on the signs of potential complications, such as infection or lead displacement, and to ensure that the patient understands the importance of adhering to follow-up care for optimal outcomes.