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In January 2018, these codes were moved to Guideline Note 173.61645 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 information below is excerpted from November 2015 VbBS meeting materials/minutes. Issue: Several new therapies for stroke have been developed which involve threading a catheter through the femoral artery to the affected artery in the brain. The stroke is then treated either by injecting thrombolytic meds directly into the affected artery or by removing the clot mechanically with or without placing a stent. Staff Recommendation (accepted by subcommittee with minimal discussion): Place CPT 61645 on SRNC as investigational because intra-arterial thrombolysis generally has not been found to have evidence for effectiveness mechanical thrombectomy has generally not been found to have high level of evidence of effectiveness in trusted sources (NICE, AHRQ) but has recommendation for use among expert guidelines. CPT codes currently used for these procedures (37184 and 37211) are not included on the stroke line (322) or other intracranial disease line. Evidence: NICE 2013 review of mechanical clot retrieval for acute ischemic stroke: efficacy is unproven and there are risks of serious complications. ARHQ 2013 evidence review for mechanical thrombectomy for the treatment of acute stroke: Paucity of high quality researchCTAF 2013 review of thrombectomy for treatment of acute stroke: Use of thrombectomy devices does not meet Technology Assessment Criteria 3 through 5 for safety, effectiveness and improvement in health outcomes. Prabhakaran 2015 systematic review of treatments for acute stroke: No recommendation made for use of intra-arterial thrombolytics. Intra-arterial therapy using stent retrievers, on the other hand, improves recanalization of proximal artery occlusions and clinical outcomes beyond that possible with IV rTPA or supportive care alone. Wardlaw 2013 Cochrane review of thrombolysis for treatment of acute stroke: No evidence of any benefit for intra-arterial over IV treatment. Evidence based guidelines:SIGN 2008 guideline for the treatment of acute stroke: Level C recommendation for mechanical thrombectomy in pts ineligible for thrombolytic drug therapy or who have failed to improve clinically or recanalise following IV thrombolysis. No recommendation made regarding intra-arterial thrombolytic therapy.NICE 2010 guideline for the treatment of acute stroke: No mention of mechanical thrombectomy or intra-arterial thrombolytic therapyJauch 2013 AHA/ASA guidelines for treatment of acute stroke: Intra-arterial fibrinolysis is beneficial in select patients who are not otherwise candidates for IV rTPA (Class I; Level of Evidence B). Intra-arterial fibrinolysis or mechanical thrombectomy is reasonable in pts with contraindications to the use of IV fibrinolysis (Class IIa; Level of Evidence C.) ................
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