scholarly journals Medicare Age-Stratified Comparative Effectiveness of Carotid Revascularization Procedures: A National Evaluation

2012 ◽  
Vol 56 (4) ◽  
pp. 1189
Author(s):  
Jeffrey Jim ◽  
Pamela L. Owens ◽  
Patrick J. Geraghty ◽  
Luis A. Sanchez ◽  
Brian G. Rubin
Keyword(s):  
Comparative Effectiveness ◽  
Carotid Revascularization ◽  
Revascularization Procedures

scholarly journals Society for Vascular Surgery (SVS) Vascular Registry evaluation of comparative effectiveness of carotid revascularization procedures stratified by Medicare age

2012 ◽  
Vol 55 (5) ◽  
pp. 1313-1321 ◽  
Author(s):  
Jeffrey Jim ◽  
Brian G. Rubin ◽  
Joseph J. Ricotta ◽  
Christopher T. Kenwood ◽  
Flora S. Siami ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Comparative Effectiveness ◽  
Carotid Revascularization ◽  
Revascularization Procedures

Cerebral vasoconstriction following CEA and the role of conventional cerebral angiography

2020 ◽  
pp. 10.1212/CPJ.0000000000000941
Author(s):  
Azam S. Tolla ◽  
Muhammad U. Farooq ◽  
Bradly Haveman-Gould ◽  
Ghassan Naisan ◽  
Philip B. Gorelick
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Cerebral Hyperperfusion Syndrome ◽  
Carotid Revascularization ◽  
Cerebral Vasoconstriction ◽  
Cerebral Hyperperfusion ◽  
Delayed Complication ◽  
Reduce Risk ◽  
Revascularization Procedures

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established cerebrovascular procedures to reduce risk of stroke. Complications include stroke, myocardial infarction, and death. A delayed complication following carotid revascularization is cerebral hyperperfusion syndrome (CHS), which can manifest as intracerebral hemorrhage (ICH)[1]. A less common delayed complication of carotid revascularization procedures is reversible cerebral vasoconstriction syndrome (RCVS).

Trends in Carotid Revascularization Procedures

JAMA ◽  
2018 ◽  
Vol 319 (3) ◽  
pp. 307
Author(s):  
Mohamad A. Hussain ◽  
Deepak L. Bhatt ◽  
Mohammed Al-Omran
Keyword(s):  
Carotid Revascularization ◽  
Revascularization Procedures

Abstract WP167: Changing Face of Carotid Revascularization Procedures in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Iqra N Akhtar ◽  
Wei Huang ◽  
Ameer E Hassan ◽  
Mohammad Rauf A Chaudhry ◽  
...  
Keyword(s):  
United States ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
The United States ◽  
Artery Stenosis ◽  
Teaching Hospitals ◽  
Trend Test ◽  
Carotid Revascularization ◽  
Asymptomatic Patients ◽  
Revascularization Procedures

Background: Carotid revascularization procedure, carotid endarterectomy (CEA) and carotid stent placement (CAS), are some of the most common procedures performed in United States and expected to change due to wider adoption of CAS. We performed this study to determine the changes in utilization of CEA and CAS in United States using nationally representative data. Methods: We used the National Inpatient Sample (NIS) from 2005 to 2014 to assess the changes in utilization of CEA and CAS over last 10 years in patients with symptomatic and asymptomatic carotid artery stenosis. NIS is the largest all payer dataset that includes diagnoses, admissions and discharge, demographics, and outcomes data of patients admitted to short stay non-Federal hospitals in the United States. We analyzed patterns of changes in utilization in various subsets of patients with carotid artery stenosis. Results: A total of 1,186,182 patients underwent carotid revascularization procedures during study period; 1,032,148 (87.1%) and 154,035 (12.9%) were CEA and CAS, respectively. The overall carotid revascularization procedures decreased over last 10 years (11.1% in 2005 to 8.4%in 2014, trend test p <.0001). Carotid revascularization in symptomatic patients increased (7.64% in 2005 to 11.01% in 2014, trend test p <.0001) while it decreased in asymptomatic patients (92.36% in 2006 to 88.99% in 2014, trend test p <.0001). There was an overall decrease in CEA (11.6% in 2005 to 8.3% in 2014, trend test <.0001) while in CAS remained unchanged (8.1% in 2005 to 8.9% in 2014, p=NS). There was an increase in carotid revascularization in teaching hospitals (40.9% in 2005 to 67.1% in 2014, trend test p <.0001) while decrease in non-teaching hospitals (50.9% in 2006 to 27.1% in 2014, trend test p <.0001). There was a decrease in carotid revascularization procedures in patients aged ≥80 years (19.8% in 2005 to 18.7% in 2014, trend test p <.0001) and CEA (19.6% in 2006 to 18.8% in 2014, trend test P<.0001) and CAS (21.2% in 2006 to 18.6% in 2014, trend test p=<.0001). Conclusion: Although CAS is increasing in a disproportionate manner within patient subgroups in United States, overall carotid revascularization procedures have decreased for unclear reasons.

Abstract W P304: Variation in Use of Carotid Revascularization Procedures and In-Hospital Mortality Among Large, Urban Teaching Hospitals in the United States

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Judith H Lichtman ◽  
Erica C Leifheit-Limson ◽  
Yun Wang ◽  
Virginia J Howard ◽  
Larry B Goldstein
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
The United States ◽  
System Level ◽  
Teaching Hospitals ◽  
Future Research ◽  
Urban Teaching ◽  
Carotid Revascularization ◽  
Hospital Variation ◽  
Revascularization Procedures

Background: Guidelines and quality improvement efforts seek to minimize variation in care and outcomes across hospitals. We assessed hospital-level variation in procedure rates and in-hospital mortality for patients hospitalized with ischemic stroke at similar hospitals in the US. The use of procedures and in-hospital mortality were not expected to vary significantly among comparable, high-volume facilities after adjusting for patient case-mix. Methods: We selected urban teaching hospitals with ≥100 annual ischemic stroke discharges (ICD-9 433, 434, 436) from the Nationwide Inpatient Sample 2010-2011. Generalized linear mixed models were used to quantify between-hospital variation in the use of carotid artery stenting (CAS) and endarterectomy (CEA), as well as in-hospital mortality, adjusting for patient characteristics. Adjusted odds ratios were calculated to reflect the odds that patients would have the procedure/outcome when treated at hospitals 1 SD above relative to hospitals 1 SD below the overall rate for that procedure/outcome (an odds ratio of 1.0 would reflect no hospital variation in the procedure/outcome). Results: A total of 105 urban teaching hospitals were selected, with a median annual volume of 453 ischemic stroke discharges (IQR 351-600). Among a total of 52,090 ischemic stroke discharges (mean age 68±14.8 yrs), the overall rates were 3.7% (SD 3.1) for CAS and 15.6% (SD 8.0) for CEA; in-hospital mortality was 4.3% (SD 1.7). The odds of receiving CAS and CEA were almost 7 and 4 times as high, respectively, for a patient treated at a hospital 1 SD above versus 1 SD below the overall rate for that procedure (CAS: 6.68, 95% CI 4.97-8.98; CEA: 3.62, 95% CI 3.17-4.13). The odds of dying for those treated at a hospital 1 SD above relative to 1 SD below the overall mortality rate were 2.09 (95% CI 1.98-2.21). Conclusions: There was marked between-hospital heterogeneity in the use of carotid revascularization procedures and in-hospital mortality among large, urban US teaching hospitals. Future research needs to identify system-level factors contributing to these variations in care and outcomes.

Socioeconomic Disparities in Carotid Revascularization Procedures

2020 ◽  
Vol 34 (7) ◽  
pp. 1836-1845
Author(s):  
Latha Panchap ◽  
Seyed A. Safavynia ◽  
Virginia Tangel ◽  
Robert S. White
Keyword(s):  
Socioeconomic Disparities ◽  
Carotid Revascularization ◽  
Revascularization Procedures

scholarly journals Lower carotid revascularization rates after stroke in racial/ethnic minority-serving US hospitals

Neurology ◽  
2019 ◽  
Vol 92 (23) ◽  
pp. e2653-e2660 ◽  
Author(s):  
Roland Faigle ◽  
Lisa A. Cooper ◽  
Rebecca F. Gottesman
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Predominantly White ◽  
Ethnic Minority ◽  
System Level ◽  
Carotid Revascularization ◽  
Logistic Regression Models ◽  
Race Disparities ◽  
Revascularization Procedures ◽  
Racial Ethnic

ObjectiveWe sought to determine whether the use of carotid revascularization procedures after stroke due to carotid stenosis differs between minority-serving hospitals and hospitals serving predominantly white patients.MethodsWe identified ischemic stroke cases due to carotid disease, identified by ICD-9-CM codes, from 2007 to 2011 in the Nationwide Inpatient Sample. The use of carotid endarterectomy (CEA) and carotid artery stenting (CAS) was recorded. Hospitals with ≥40% racial/ethnic minority patients (minority-serving hospitals) were compared to hospitals with <40% minority patients (predominantly white hospitals [hereafter, abbreviated to white]). Logistic regression was used to evaluate the use of CEA/CAS among minority-serving and white hospitals.ResultsOf the 26,189 ischemic stroke cases meeting inclusion criteria, 20,870 (79.7%) were treated at 1,113 white hospitals and 5,319 (20.3%) received care at 325 minority-serving hospitals. Compared to patients in white hospitals, patients in minority-serving hospitals were less likely to undergo CEA/CAS (17.6%, 95% confidence interval [CI] 16.6%–18.6%, in minority-serving vs 21.2%, 95% CI 20.7%–21.8%, in white hospitals; p < 0.001). In fully adjusted logistic regression models, the odds of CEA/CAS were lower in minority-serving compared to white hospitals (odds ratio 0.81, 95% CI 0.70–0.93), independent of individual patient race/ethnicity and other measured hospital characteristics. White and Hispanic individuals had significantly lower odds of CEA/CAS in minority-serving compared to white hospitals. Patient-level racial/ethnic differences in the use of carotid revascularization procedures remained within each hospital stratum.ConclusionThe odds of carotid revascularization after stroke is lower in minority- compared to white-serving hospitals, suggesting system-level factors as a major contributor to explain race disparities in the use of carotid revascularization.

Abstract WMP106: Increased Carotid Stenting For Nonspecific Symptoms In The Post-crest Era

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Mahmoud Rayes ◽  
Pratik Bhattacharya ◽  
Rahul Damani ◽  
Seemant Chaturvedi
Keyword(s):  
Primary Care Physicians ◽  
Medical Center ◽  
Carotid Stenting ◽  
Posterior Circulation ◽  
Complication Rates ◽  
Carotid Revascularization ◽  
Carotid Circulation ◽  
Revascularization Procedures ◽  
Specific Symptoms ◽  
Stroke Death

Background: Nonspecific symptoms such as dizziness and syncope may prompt evaluation of the carotid circulation and detection of carotid stenosis. The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) demonstrated equivalent outcomes from Endarterectomy (CEA) and Stenting (CAS) in asymptomatic stenosis. We reviewed the trends in selection and outcomes from revascularization procedures for nonspecific symptoms in the light of CREST results. Methods: We performed a retrospective review of carotid revascularization procedures at a large volume urban medical center, between June 2009 (8 months pre-CREST) and April 2012. Demographics, surgical risk features and in-hospital outcomes of stroke/death/MI were reviewed. Patients were labeled as having nonspecific symptoms when they presented with posterior circulation symptoms or with non-focal symptoms i.e. Dizziness, syncope, etc. To evaluate the effect of CREST, we compared pre CREST (up to Jan 2010) and post CREST cases (Feb 2010 to Apr 2012). Results: 701 procedures (36.1% CEA, 63.9% CAS) were performed and mean age was 70 ±10 years. Non-specific indications accounted for 13% of CEA and 15.9% of CAS. Procedures for nonspecific symptoms did not increase post CREST in the CEA group (12.1% VS 13.3%). They increased significantly in the CAS group (6.3% pre and 18.5% post CREST). Among CAS, the rise was insignificant in the first 8 months (Feb 2010-Sep 2010) post CREST: 7.5%. This rose to 21.2% from Oct 2010 to May 2011: p=0.0017; and 23.8% from June 2011 to April 2012: p=0.0004. The rise in CAS was noted among elderly patients (>70 years), a group in which CREST demonstrated higher complication rates. The rise was noted among both men and women and they did not have surgical high-risk criteria. In-hospital complication rates of stroke/death/MI were 5.6% in this group. Most complications occurred in patients >70 years. Conclusion: CAS for nonspecific symptoms has increased following CREST, and the complication rates associated with these procedures is significant. This raises concern about the value of this procedure. Primary care physicians evaluating non-specific symptoms should obtain neurological expertise prior to revascularization procedures, to allow appropriate patient selection.

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