Carotid artery stent placement for asymptomatic extracranial carotid stenosis

NICE interventional procedure guidance [IPG388] Published date:

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The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Carotid artery stent placement for asymptomatic extracranial carotid stenosis.

NICE has also produced guidance on the following procedure: Carotid artery stent placement for symptomatic extracranial carotid stenosis

  • Description

    The main arteries in the neck (the carotid arteries) can become narrowed by fatty deposits. Blood clots can form on these fatty deposits and fragments can detach and lodge in thinner arteries that supply blood to parts of the brain, causing a transient ischaemic attack (TIA, sometimes called a ‘mini stroke’) or a stroke. Patients who are asymptomatic have this narrowing but without any previous health problems resulting from it.

    In this procedure a metal mesh called a stent is used to widen the narrowed carotid artery. This procedure does not involve making a cut in the neck. Instead a fine wire is inserted into an artery in the leg and passed up into the carotid artery, and the stent is then moved into place along the wire. Some stenting also includes protective devices, to help to prevent any fragments loosened by the stent insertion from reaching smaller arteries and causing a stroke.

  • OPCS4.6 Code(s)

    L31.4 Percutaneous transluminal insertion of stent into carotid artery

    Note: Use a supplementary code for placement of stent (L76, L89, O20)

    A code from  category L76.- Endovascular placement of stent or L89.- Other endovascular placement of stent or O20.- Endovascular placement of stent graft is added to specify the type and number of stents used.

    Y53.- Approach to organ under image control

    Note: Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to organ under image control is assigned.

    In addition the ICD-10 codes I65.2 Occlusion and stenosis of carotid arteryorI65.3 Occlusion and stenosis of multiple and bilateral precerebral arteriesflutter would be recorded. It is not possible to specify that the carotid stenosis is asymptomatic.

    The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.

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