Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)

This policy covers endovascular treatment of intracranial arterial disease, including endovascular therapy for atherosclerotic lesions, repair of intracranial aneurysms (including intracranial stent placement and FDA‑approved flow‑diverting stents where indicated), and mechanical thrombectomy for acute ischemic stroke. Coverage is limited to patients who meet specified anatomic and trial‑based clinical and imaging criteria (e.g., proximal anterior‑circulation occlusions with substantial neurologic deficit, imaging evidence of salvageable tissue, NIHSS thresholds, and treatment within 12 hours—or up to 24 hours with documented clinical–imaging mismatch per DAWN/DEFUSE‑3), excludes extracranial or non‑specified vessel locations and cases with intracranial hemorrhage or arterial dissection, and considers procedures not meeting these criteria experimental/investigational.

"Endovascular treatment of intracranial atherosclerotic arterial disease"