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Long-term outcomes of carotid endarterectomy vs transfemoral carotid stenting in a Medicare-matched database
Carotid endarterectomy (CEA) is associated with lower risk of perioperative stroke compared with transfemoral carotid artery stenting (TFCAS) in the treatment of carotid artery stenosis. However, there is discrepancy in data regarding long-term outcomes. We aimed to compare long-term outcomes of CEA vs TFCAS using the Medicare-matched Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database.
Source: Journal of Vascular Surgery - August 25, 2023 Category: Surgery Authors: Kevin S. Yei, Claire Janssen, Nadin Elsayed, Isaac Naazie, Art Sedrakyan, Mahmoud B. Malas Source Type: research

Long-Term Outcomes of Carotid Endarterectomy vs. Transfemoral Carotid Stenting in a Medicare-Matched Database
Carotid endarterectomy is associated with lower risk of perioperative stroke compared to transfemoral carotid artery stenting in the treatment of carotid artery stenosis. However, there is discrepancy in data regarding long-term outcomes. We aimed to compare long-term outcomes of carotid endarterectomy vs transfemoral carotid artery stenting using the Medicare-matched Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database.
Source: Journal of Vascular Surgery - August 25, 2023 Category: Surgery Authors: Kevin S. Yei, Claire Janssen, Nadin Elsayed, Isaac Naazie, Art Sedrakyan, Mahmoud B. Malas Source Type: research

One-Year Outcomes of Transcarotid Artery Revascularization Versus Transfemoral Carotid Artery Stenting in a Medicare Database
Transfemoral carotid artery stenting (TFCAS) was introduced as a minimally invasive option for high-risk patients not eligible for carotid endarterectomy. However, TFCAS was found to be associated with higher rates of perioperative stroke. This was attributed to the unprotected manipulation of the aortic arch and carotid atherosclerotic lesion. Therefore, transcarotid artery revascularization (TCAR) was introduced as a hybrid alternative to TFCAS. Prior studies have shown a significantly lower risk of perioperative stroke and death compared with TFCAS.
Source: Journal of Vascular Surgery - May 19, 2022 Category: Surgery Authors: Nadin Elsayed, Kevin Yei, Marc L. Schermerhorn, Philip P. Goodney, Mahmoud B. Malas Tags: IP: Interactive Poster Session Source Type: research

One-year Outcomes of Transcarotid Artery Revascularization vs Carotid Endarterectomy in Medicare Database
Carotid endarterectomy (CEA) has played a major part in reducing stroke in patients with significant carotid artery stenosis. Transcarotid artery revascularization (TCAR) was introduced as a minimally invasive hybrid procedure to treat patients who are considered anatomically and/or medically high risk for CEA. Prior studies reported no differences in perioperative stroke/death between TCAR and CEA. However, data regarding 1-year outcomes of TCAR vs CEA are scarce, and all prior studies had only about 50% follow up at 1  year.
Source: Journal of Vascular Surgery - May 19, 2022 Category: Surgery Authors: Nadin Elsayed, Kevin Yei, Raghu L. Motaganahalli, Marc L. Schermerhorn, Mahmoud B. Malas Tags: IYSC: International Young Surgeons Competition Source Type: research

Rules of engagement: The delicate dance between vascular surgeons, industrial partners, and patient outcomes
In 1953, Michael E. DeBakey performed the first carotid endarterectomy successfully. It would be almost 60  years until a new technique disrupted the carotid world with as much furor. In 2012, transcarotid artery revascularization (TCAR) burst onto the scene. With its minimally invasive, hybrid appeal and equivalency to carotid endarterectomy stroke risk, TCAR quickly won the hearts of many vascular sur geons. The update of TCAR technology was rapid, increasing dramatically at 15% annually, with a real jolt coming in 2016 when the Centers for Medicare& Medicaid Services allowed coverage for TCAR under the existing nationa...
Source: Journal of Vascular Surgery - November 19, 2021 Category: Surgery Authors: Anahita Dua Tags: Invited commentary Source Type: research

Expansion of Transcarotid Artery Revascularization to Standard Risk Patients for Treatment of Carotid Artery Stenosis
Transcarotid artery revascularization (TCAR) is currently reimbursed by the Centers for Medicare and Medicaid Services for treatment of medically and anatomically high-risk patients. TCAR has been found to be associated with equivalent stroke/death outcomes compared with carotid endarterectomy (CEA) for high-risk patients. However, the safety profile of TCAR in standard-risk patients is currently not well-defined and has limited its expansion of use in this patient population.
Source: Journal of Vascular Surgery - August 24, 2021 Category: Surgery Authors: Patric Liang, Jack Cronenwett, Eric Secemsky, Jens Eldrup-Jorgensen, Mahmoud Malas, Grace J. Wang, Brian Nolan, Vikram S. Kashyap, Raghu L. Motaganahalli, Marc L. Schermerhorn Tags: S2: Plenary Session 2 Source Type: research

Delayed Carotid Endarterectomy After Admission in Symptomatic Carotid Artery Disease Is Associated With Lower Postoperative Stroke Rates in the Medicare Population
The appropriate timing of carotid endarterectomy (CEA) in symptomatic carotid artery disease is still controversial. Despite guideline recommendations to perform CEA within 14 days, recent studies have favored delayed CEA to decrease the risk of postoperative stroke. The goal of this study was to evaluate the timing of CEA for symptomatic disease in the Medicare population and its effects on postoperative stroke rates.
Source: Journal of Vascular Surgery - August 21, 2019 Category: Surgery Authors: Nathan Itoga, Pavlos Tsantilas, Manuel Garcia-Toca, John Harris Tags: Abstract from the 2019 Western Vascular Society Annual Meeting Source Type: research

VESS05. In-Hospital Outcomes of Transcarotid Artery Revascularization and Carotid Endarterectomy in the Society for Vascular Surgery Vascular Quality Initiative
This study compares initial in-hospital outcomes of CEA and TCAR using the Society for Vascular Surgery (SVS) Vascular Quality Initiative TCAR Surveillance Project done in collaboration with the Centers for Medicare and Medicaid Services to create more information for future coverage decisions.
Source: Journal of Vascular Surgery - May 22, 2018 Category: Surgery Authors: Marc L. Schermerhorn, Hanaa Dakour Aridi, Vikram S. Kashyap, Grace J. Wang, Brian Nolan, Jack Cronenwett, Jens Eldrup-Jorgensen, Mahmoud B. Malas Source Type: research

Trends in Carotid Revascularization Procedures
To the Editor In a study of Medicare beneficiaries during 1999-2014, 30-day ischemic stroke or death rates after carotid endarterectomy improved (from 4.4% in 1999-2000 to 3.1% in 2013-2014), as did all-cause mortality (from 1.6% to 1.1%). In contrast, 30-day ischemic stroke or death rates after carotid artery stenting did not differ between the beginning and the end of the study period (7.0% in 1999-2000 and 7.0% in 2013-2014) and neither did all-cause mortality (4.7% in 1999-2000 and 4.8% in 2013-2014). Importantly, 30-day ischemic stroke or death rates after carotid artery stenting were higher than those recommended by ...
Source: JAMA - January 16, 2018 Category: General Medicine Source Type: research

Trends in Carotid Revascularization Procedures —Reply
In Reply Dr Hussain and colleagues point out interesting comparisons in carotid revascularization trends in Ontario, Canada, and in the US Medicare population, including similar 30-day stroke or death outcomes after carotid endarterectomy and stenting. We agree that differing reimbursement policies in the United States and Canada may account for differing patterns of carotid stenting after 2006. A noted difference is the lower receipt of procedures among symptomatic patients in the United States vs Ontario. However, such variation is expected because the approach to asymptomatic treatment has been shown to vary among Western countries.
Source: JAMA - January 16, 2018 Category: General Medicine Source Type: research

IP131. Transfemoral Carotid Angioplasty and Stenting With Embolic Protection: A 7-year Retrospective Analysis of a Single-Center Experience
Carotid angioplasty and stenting (CAS) is an excellent, often superior, alternative to carotid endarterectomy (CEA). When performed by experienced operators, both are equivalent in periprocedural risk and stroke prevention. Widespread adoption of CAS in the United States has been impeded by reimbursement regulations mandated by the Centers for Medicare and Medicaid Services (CMS) that favor CEA over CAS for patients with asymptomatic carotid disease. This policy has led to decreased CAS volumes and an increase in percentages of patients receiving CAS for symptomatic vs asymptomatic disease.
Source: Journal of Vascular Surgery - May 17, 2017 Category: Surgery Authors: Michael B. Silva, Garold Motes, Zulfiqar Faisal. Cheema, Grant Fankhauser, Nikita Tihonov, Jennifer Worsham, Kaled Diab, Charlie Cheng Tags: IP: Interactive Poster Session Source Type: research

Silk Road touts low stroke rate in 2 studies of Enroute TCAR system
Silk Road Medical yesterday released data from 2 studies of its Enroute transcarotid neuroprotection and stent system, including 1-year data from a pivotal trial of the device and an interim analysis of a post-approval study of the Enroute. Data from the studies was presented last month at the 44th annual Veith Symposium in New York. The Sunnyvale, Calif.-based company touts the Enroute system and stent as the 1st and only devices currently approved for transcarotid artery revascularization procedures by the FDA. Silk Road presented data from the Roadster 1 pivotal trial of the TCAR system, which examined the use of ...
Source: Mass Device - December 13, 2016 Category: Medical Equipment Authors: Fink Densford Tags: Clinical Trials Vascular Silk Road Medical Inc. Source Type: news

Silk Road Medical touts Medicare coverage decision for carotid procedures
Silk Road Medical said yesterday the Centers for Medicare and Medicaid Services granted coverage for transcarotid artery revascularization procedures, including those performed with the company’s Enroute transcarotid neuroprotection and stent system. The TCAR procedures are now eligible for coverage for patients who are treated with FDA-approved proximal embolic protection devices and approved carotid artery stent systems indicated for transcarotid procedures. The devices are also required to be entered into the national TCAR Surveillance Project, Sunnyvale, Calif.-based Silk Road Medical said. The company said it...
Source: Mass Device - September 16, 2016 Category: Medical Equipment Authors: Fink Densford Tags: Catheters Stents Vascular Centers for Medicare and Medicaid Services (CMS) Silk Road Medical Inc. Source Type: news

Comparative Effectiveness of Carotid Artery Stenting Versus Carotid Endarterectomy Among Medicare Beneficiaries Original Articles
Conclusions— Outcomes after CAS and CEA among Medicare beneficiaries were comparable after adjusting for both patient- and provider-level factors.
Source: Circulation: Cardiovascular Quality and Outcomes - May 16, 2016 Category: Cardiology Authors: Jalbert, J. J., Nguyen, L. L., Gerhard-Herman, M. D., Kumamaru, H., Chen, C.-Y., Williams, L. A., Liu, J., Rothman, A. T., Jaff, M. R., Seeger, J. D., Benenati, J. F., Schneider, P. A., Aronow, H. D., Johnston, J. A., Brott, T. G., Tsai, T. T., White, C. Tags: Revascularization, Stent, Cerebrovascular Procedures, Stenosis Original Articles Source Type: research

Current Risks of Asymptomatic Carotid Stenosis
In the past 2 decades, 2 large multicenter trials have demonstrated the efficacy of carotid endarterectomy (CEA) for patients with asymptomatic carotid stenosis: the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial (ACST). These trials found that CEA, compared with best medical therapy, was associated with a significant relative risk reduction of 50% during 5 years but only an absolute reduction in ipsilateral stroke of 0.5% to 1% per year. With the number needed to treat to prevent 1 stroke in 1 year approaching 100 to 200, whether this degree of stroke reduction is clinically s...
Source: JAMA Neurology - September 21, 2015 Category: Neurology Source Type: research

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