CPT® Code 61645

Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s)

The procedure described by CPT® Code 61645 involves a specialized technique for addressing intracranial blood clots through a minimally invasive approach. This procedure is designed to mechanically remove or dissolve blood clots that obstruct blood flow within the intracranial vessels. The term "percutaneous" indicates that access to the blood vessels is achieved through the skin, typically via a peripheral artery, rather than through an open surgical method. The process begins with the introduction of a needle into the artery, guided by fluoroscopic imaging, which allows for real-time visualization of the blood vessels. A thin wire, known as a guidewire, is then threaded through the needle and navigated to the site of the occlusion. If diagnostic angiography is indicated, a catheter is placed over the guidewire and advanced to the area of blockage. This step is crucial for obtaining detailed images of the intracranial blood vessels, which aids in assessing the extent of the clot and planning the subsequent intervention. After the guidewire is repositioned, a contrast dye is injected to enhance the visibility of the vessels during imaging. Following this, a mechanical device, such as an aspiration catheter or retriever, is utilized to evacuate the clot. In conjunction with mechanical thrombectomy, thrombolytic agents—medications that dissolve clots—may be infused to facilitate the breakdown of the clot. These agents can include tissue plasminogen activator, urokinase, and others, which are delivered through an infusion catheter placed at the clot site. Throughout the procedure, the effectiveness of the treatment is monitored using periodic angiograms to assess clot lysis. The comprehensive nature of this procedure, as encapsulated in CPT® Code 61645, includes all necessary components such as diagnostic angiography, fluoroscopic guidance, catheter placement, and the administration of thrombolytic injections.