CPT® Code 0426T

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 are explicitly noted as potential causes for CSA:

• Cardiovascular Disease - Conditions affecting the heart and blood vessels that may disrupt normal respiratory function.
• Stroke - A cerebrovascular event that can impair the brain's ability to regulate breathing.
• Conditions Affecting the Neck or Brainstem - Anatomical or pathological issues in these areas can interfere with the signals necessary for breathing.
• Morbid Obesity - Excess body weight that can contribute to respiratory difficulties, including CSA.
• Narcotic Use - The use of narcotic medications can depress the central nervous system, leading to episodes of apnea.

2. Procedure

The procedure involves several detailed steps to ensure the successful insertion or replacement of the neurostimulator system:

• Step 1: The patient is placed under conscious sedation, allowing for communication with the physician during the procedure. 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, and two long access wires are advanced into the vena cava to facilitate further catheterization.
• Step 3: A guide catheter is 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 left subclavian junction.
• Step 4: Using contrast, venous branches are identified, and an inner catheter is threaded into the guide catheter, telescoping 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 further advanced, and the inner catheter is removed. The stimulation lead is then loaded and deployed through the guide catheter to the designated target location.
• Step 7: The sensing lead is deployed by 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 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 lead.
• Step 10: Lead placement is assessed, and stimulation is measured to ensure complete contraction of the hemidiaphragm.
• Step 11: The pulse generator and implanted leads are connected, with the generator being 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 unit is checked to ensure proper operation.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications and ensuring the proper functioning of the neurostimulator system. Patients may be observed for signs of infection at the incision site, as well as for any adverse reactions to sedation. Follow-up appointments are typically scheduled to assess the effectiveness of the neurostimulator in managing central sleep apnea and to make any necessary adjustments to the system. Patients are advised on activity restrictions and signs to watch for that may indicate complications, such as unusual pain or changes in breathing patterns.