Cerebrovascular Intervention Guidelines

Cerebrovascular endovascular procedures are covered for specific indications—symptomatic/ruptured aneurysms (any ruptured size; unruptured >5 mm), AVMs (any size), symptomatic carotid stenosis/crescendo TIAs/critical limb ischemia, defined middle meningeal artery embolization scenarios (e.g., asymptomatic CSDH ≥8 mm, adjunct to surgery, coagulopathy/antiplatelet patients, or prophylactic post‑evacuation), emergent cerebrovascular conditions, and narrowly for IIH venous sinus stenting—while treatments for intracranial atherosclerosis and prophylactic intracranial angioplasty after aneurysmal SAH are excluded unless a dual diagnosis of SAH and ischemia exists (stenting of ruptured aneurysms only when no safer option). Key requirements include detailed documentation of procedure rationale, prior/conservative treatments and responses, recent imaging/clinical evaluations within 6 months, and for IIH stenting all criteria must be met (papilledema with vision risk, ICP >25 cm H2O, failed medical therapy including acetazolamide, venous stenosis >30% with >8 mmHg gradient on catheter venogram, and ability to tolerate ASA+clopidogrel for 3–6 months); submit prior authorization ≥2 weeks before elective surgery.