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Management: Medicare
Procedure: Carotid Endarterectomy

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Total 22 results found since Jan 2013.

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

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

The current national criteria for carotid artery stenting overestimate its efficacy in patients who are symptomatic and at high risk
In this study, we stratified patients who underwent CAS or CEA by CMS high-risk criteria and symptom status and examined their 30-day outcomes.Methods: A nonrandomized, retrospective cohort study was performed by chart review of all patients undergoing CEA or CAS from January 1, 2005, to December 31, 2010, at our institution. Demographic data and data pertaining to the presence or absence of high-risk factors were collected. Patients were stratified using symptom status and high-risk status as variables, and 30-day adverse events (stroke, death, myocardial infarction [MI]) were compared.Results: A total of 271 patients und...
Source: Journal of Vascular Surgery - April 8, 2013 Category: Surgery Authors: Shunsuke Yoshida, Rodney P. Bensley, Julia D. Glaser, Christoph S. Nabzdyk, Allen D. Hamdan, Mark C. Wyers, Elliot L. Chaikof, Marc L. Schermerhorn Tags: Clinical research studies 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

The impact of Centers for Medicare and Medicaid Services high-risk criteria on outcome after carotid endarterectomy and carotid artery stenting in the SVS Vascular Registry
Objective: The Centers for Medicare and Medicaid Services (CMS) require high-risk (HR) criteria for carotid artery stenting (CAS) reimbursement. The impact of these criteria on outcomes after carotid endarterectomy (CEA) and CAS remains uncertain. Additionally, if these HR criteria are associated with more adverse events after CAS, then existing comparative effectiveness analysis of CEA vs CAS may be biased. We sought to elucidate this using data from the SVS Vascular Registry.Methods: We analyzed 10,107 patients undergoing CEA (6370) and CAS (3737), stratified by CMS HR criteria. The primary endpoint was composite death,...
Source: Journal of Vascular Surgery - February 13, 2013 Category: Surgery Authors: Marc L. Schermerhorn, Margriet Fokkema, Philip Goodney, Ellen D. Dillavou, Jeffrey Jim, Christopher T. Kenwood, Flora S. Siami, Rodney A. White, SVS Outcomes Committee Tags: Clinical research studies 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

Accuracy of administrative data versus clinical data to evaluate carotid endarterectomy and carotid stenting
Conclusions: Administrative data are unreliable for determining symptom status, high-risk status, and perioperative stroke and should not be used to analyze CEA and CAS. NSQIP data do not adequately identify high-risk patients, but do accurately identify perioperative strokes and to a lesser degree, symptom status.
Source: Journal of Vascular Surgery - March 13, 2013 Category: Surgery Authors: Rodney P. Bensley, Shunsuke Yoshida, Ruby C. Lo, Margriet Fokkema, Allen D. Hamdan, Mark C. Wyers, Elliot L. Chaikof, Marc L. Schermerhorn Tags: Clinical research studies 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

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

Model Feedback in Bayesian Propensity Score Estimation
Summary Methods based on the propensity score comprise one set of valuable tools for comparative effectiveness research and for estimating causal effects more generally. These methods typically consist of two distinct stages: (1) a propensity score stage where a model is fit to predict the propensity to receive treatment (the propensity score), and (2) an outcome stage where responses are compared in treated and untreated units having similar values of the estimated propensity score. Traditional techniques conduct estimation in these two stages separately; estimates from the first stage are treated as fixed and known for u...
Source: Biometrics - February 4, 2013 Category: Biotechnology Authors: Corwin M. Zigler, Krista Watts, Robert W. Yeh, Yun Wang, Brent A. Coull, Francesca Dominici Source Type: research

Abstract 28: Readmissions after Carotid Artery Revascularization in the Medicare Population Session Title: Concurrent III Session A: Oral Abstracts on Outcomes Issues
Conclusions: Almost 10% of Medicare patients undergoing carotid revascularization were readmitted within 30 days of discharge. Compared with CEA, CAS was associated with higher 30-day readmission rates. However, hospitals’ RSRR did not differ by their proportional use of CAS volume. Efforts to identify readmission risk factors are needed to reduce rates of readmissions following carotid revascularization.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Al-Damluji, M. S., Zhang, W., Stilp, E., Geary, L., Mena-Hurtado, C., Curtis, J. P. Tags: Session Title: Concurrent III Session A: Oral Abstracts on Outcomes Issues Source Type: research

Readmissions After Carotid Artery Revascularization in the Medicare Population
ConclusionsAlmost 10% of Medicare patients undergoing carotid revascularization were readmitted within 30 days of discharge. Compared with CEA, CAS was associated with a greater readmission risk. However, hospitals' RSRR did not differ by their proportional CAS use.
Source: Journal of the American College of Cardiology - April 6, 2015 Category: Cardiology Source Type: research

Surgeon Case Volume and 30-Day Mortality After Carotid Endarterectomy Among Contemporary Medicare Beneficiaries: Before and After National Coverage Determination for Carotid Artery Stenting Clinical Sciences
Conclusions— The rate of CEA procedures decreased substantially during 2001 to 2008, as did surgeon past-year case-volume. The postprocedural mortality in Medicare beneficiaries was high compared with trial patients but somewhat improved over time. Those operated by lower past-year case-volume surgeons had increased mortality.
Source: Stroke - April 27, 2015 Category: Neurology Authors: Kumamaru, H., Jalbert, J. J., Nguyen, L. L., Gerhard-Herman, M. D., Williams, L. A., Chen, C.-Y., Seeger, J. D., Liu, J., Franklin, J. M., Setoguchi, S. Tags: Health policy and outcome research, Carotid Stenosis, Carotid endarterectomy Clinical Sciences Source Type: research

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

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