Percutaneous Transluminal Angioplasty of Intracranial Atherosclerotic Stenoses With or Without Stenting
DESCRIPTION
Percutaneous transluminal angioplasty (PTA) involves inserting a balloon catheter into a narrow or occluded vessel to recanalize and dilate the vessel by inflating the balloon. The intent of PTA is to improve blood flow through the diseased section of the vessel so the vessel patency is increased and embolization is decreased. Technical difficulties in catheter and stent designs, along with the risk of embolism, have resulted in a slow and cautious approach towards intracranial PTA.
POLICY
Percutaneous transluminal angioplasty for the treatment of intracranial stenoses with or without stenting is considered investigational.
Policies with similar titles: Percutaneous Transluminal Angioplasty of the Aortic Arch Vessels with or without stenting (Brachiocephalic, Carotid, Subclavian & Vertebral Arteries) and of Coarctation of the Aorta
ADDITIONAL INFORMATION
Well-designed, randomized, controlled trials with long-term follow-up are not available to determine long-term benefits of percutaneous transluminal angioplasty for the treatment of intracranial stenoses compared to alternative treatments.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (8:2009). Percutaneous transluminal angioplasty of intracranial atherosclerotic stenoses with or without stenting (2.01.54). Retrieved March 4, 2010 from BlueWeb. (18 articles and/or guidelines reviewed)
Bose, A., Hartmann, M., Henkes, H., Liu, H., Teng, M., Szikora, I., et al. (2007). A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenosis: the Wingspan study. Stroke, 38 (5), 1531 - 1537. (Level 2 Evidence)
Complete Guide to Medicare Coverage Issues [Computer software]. (2009, November). Percutaneous transluminal angioplasty (PTA) (NCD 20.7, p. 2-7 - 2-11). The Ingenix Complete Guide to Medicare Coverage Issues.
Fiorella, D., Levy, E., Turk, A., Albuquerque, F., Pride, G., Woo, H., et al. (2009). Target lesion revascularization after wingspan: assessment of safety and durability. Stroke, 40 (1), 106 - 110. (Level 5 Evidence)
Hacein-Bay, L., & Varekas, P. N. (2006). Intracranial angioplasty and stenting for cerebrovascular disease. Neurologic Clinics, 24 (4), 697 - 713.
Hayes. Medical Technology Directory. (2009, September ). Carotid angioplasty and stenting for carotid artery stenosis. Retrieved February 25, 2010 from: www.Hayesinc.com/subscribers. (129 articles and/or guidelines reviewed)
Higashida, R. T., Meyers, P. M., Connors, J. J. III, Sacks, D., Strother, C. M., Barr, J., et al. (2005, October). Intracranial angioplasty & stenting for cerebral atherosclerosis: A position statement of the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, and the American Society of Neuroradiology. Journal of Vascular and Interventional Radiology, 16 (10), 1281 - 1285.
Jiang, W. J., Xu, X. T., Du, B., Dong, K. H., Jin, M., Wang, Q. H., et al. (2007). Comparison of elective stenting of severe vs moderate intracranial atherosclerotic stenosis. Neurology, 68 (6), 420 - 426. (Level 3 Evidence)
Jiang, W., Xu, X., Jin, M., Du, B., Dong, K., & Dai, J. (2007). Apollo stent for symptomatic atherosclerotic intracranial stenosis: study results. AJNR American Journal of Neuroradiology, 28 (5), 830 - 834. (Level 2 Evidence)
Meyers, P., Schumacher, H., Higashida, R., Bamwell, S., Creager,M., Gupta, R., et al. (2009). Indications for the performance of intracranial endovascular neuron-interventional procedures: a scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research. Circulation, 119 (16), 2235 - 2249.
National Guideline Clearinghouse. National Center for Primary Care. (2008 January). ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. Retrieved February 25, 2010 from: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=12193&string=guideline+AND+update+AND+percutaneous+AND+coronary+AND+intervention.
National Institute for Health and Clinical Excellence. (2007, October). Endovascular stent insertion for intracranial atherosclerotic disease. Retrieved March 3, 2010 from: http://www.nice.org.uk/nicemedia/pdf/IPG233Guidance.pdf.
Schumacher, H., Meyers, P., Higashida, R., Derdeyn, C., Lavine, S., Nesbit, G., et al. (2009). Reporting standards for angioplasty and stent - assisted angioplasty for intracranial atherosclerosis. Stroke, 40 (5), e348 - 365. (Level 5 Evidence)
Turk, A., Levy, E., Albuquerque, F., Pride, G., Woo, H., Welch, B. et al. (2008). Influence of patient age and stenosis location on wingspan in-stent restenosis. AJNR American Journal of Neuroradiology, 29 (1), 23 - 27. (Level 2 Evidence)
U. S. Department of Health & Human Services. Centers for Medicare & Medicaid Services. National Coverage Analyses. (January, 2009). NCD for Percutaneous transluminal angioplasty (20.7). Retrieved February 25, 2010 from: http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=20.7&ncd_version=8&basket=ncd%3A20%2E7%3A8%3APercutaneous+Transluminal+Angioplasty+%28PTA%29.
U. S. Food and Drug Administration. (2002, August). Center for Devices and Radiological Health. NEUROLINK® System - H010004. Retrieved January 15, 2008 from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cftopic/pma/pma.cfm?num=H010004. .
U. S. Food and Drug Administration. (2005, August). Center for Devices and Radiological Health. Wingspan stent system with Gateway PTA balloon catheter - H050001. Retrieved March 02, 2010 from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cftopic/pma/pma.cfm?num=H050001. .
ORIGINAL EFFECTIVE DATE: 8/12/2006
MOST RECENT REVIEW DATE: 3/11/2010
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.