CPT® Code 35642

A carotid-vertebral bypass graft, coded as CPT® 35642, is a surgical procedure designed to create an alternative pathway for blood flow around a diseased or obstructed segment of the vertebral artery. This procedure is particularly important for patients who have significant blockages that could impair blood supply to critical areas of the brain. The vertebral arteries, which are essential for supplying blood to the brainstem, cerebellum, and occipital lobes, originate from the brachiocephalic artery on the right side and the subclavian artery on the left side. They travel through the cervical vertebrae, specifically from the C6 transverse process to the base of the skull, where they transition from an extracranial segment to an intracranial segment. During the procedure, a synthetic graft is utilized instead of a vein, which is significant as it allows for a more durable and reliable bypass. The surgical approach involves making an incision over the obstructed area of the vertebral artery, carefully dissecting the artery from surrounding tissues, and then attaching the synthetic graft to restore blood flow. This procedure is critical for maintaining adequate cerebral perfusion and preventing neurological deficits that may arise from compromised blood flow due to vertebral artery obstruction.