Clinical Context
A typical patient is a 68-year-old male with progressive right-sided carotid occlusive disease and contralateral high-grade stenosis who presents with recurrent transient ischemic attacks (TIAs) despite maximal medical therapy. Preoperative evaluation includes carotid duplex ultrasound showing an occluded right internal carotid artery and 80% stenosis of the left internal carotid artery, CTA of the neck and chest to define anatomy, and cardiac evaluation to assess surgical risk. The vascular surgery team plans a cross-neck carotid bypass using a prosthetic tube graft (CPT 35602) to re-establish flow to the occluded carotid circulation and protect cerebral perfusion during an anticipated staged aortic arch or complex carotid reconstruction.
Perioperative workflow: the patient is admitted, consented, and optimized (antiplatelet management, blood pressure control). In the operating room under general anesthesia, bilateral neck exposures are performed, the prosthetic graft is measured and tunneled subcutaneously across the neck, and end-to-side anastomoses are constructed between the donor and recipient carotid arteries. Intraoperative neuromonitoring (EEG/SSEP) and completion angiography or duplex confirm patency. Postoperative care includes ICU monitoring for neurologic status, blood pressure control, antiplatelet therapy, and staged imaging prior to discharge and follow-up surveillance duplex ultrasound.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
36215 | Selective catheter placement, carotid, unilateral, with angiography radiological supervision and interpretation | Used for diagnostic cerebral/neck angiography preoperatively or intraoperatively to define anatomy and confirm graft patency |
36247 | Introduction of catheter, arterial, retrograde, for diagnostic cerebral angiography | Alternative access angiography code for diagnostic vascular imaging associated with planning or completion angiograms
35301 | Transposition of carotid artery (e.g., subclavian-carotid transposition) | Related open revascularization technique; may be an alternative to a cross-neck prosthetic bypass depending on anatomy
33405 | Repair of aortic arch or ascending aorta (example code for open arch procedures) | Represents major aortic procedures during which carotid flow may be rerouted or bypassed; included when carotid bypass is adjunctive in aortic repair
93880 | Duplex scan of extracranial arteries, complete bilateral study | Common postoperative and surveillance imaging to assess graft patency and flow after carotid bypass
92920 | Percutaneous transluminal balloon angioplasty, peripheral arterial, femoral-popliteal, etc. (representative endovascular revascularization) | Represents potential endovascular adjuncts or staged procedures when hybrid approaches are used