0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial | Health Care Reform

Dramatic Increases in Carotid Stenting Despite Nonconclusive Data

Seth A. Berkowitz, MD; Rita F. Redberg, MD, MSc, Editor
Arch Intern Med. 2011;171(20):1794-1795. doi:10.1001/archinternmed.2011.540.
Text Size: A A A
Published online

Extract

In little more than a decade, the use of carotid stenting for prevention of cerebrovascular events has grown greatly. In 1998, roughly 0.1 per 1000 Medicare beneficiaries per year received a carotid stenting procedure. By 2007, that number had increased to 0.6 procedures per 1000 beneficiaries per year.1 Overall rates of carotid revascularization decreased during this period, suggesting that carotid stenting was substituted for carotid endarterectomy (CEA). Even more dramatically, coincident with widespread Medicare coverage of carotid stenting beginning in October 2004, there was a quadrupling of procedures in 2 years.2 From 2004 to 2006, the number of stenting procedures increased from a mean of 266 per month to 1015 per month. Furthermore, prior to widespread Medicare coverage, 82% of carotid stent recipients had a diagnosis of prior transient ischemic attack (TIA) (3756 of 4590), while in the era after widespread coverage only 23% (1216 of 5354) had a diagnosis of prior TIA. This change suggests an increased rate of implant procedures in asymptomatic patients. In fact, some authors estimate that 70% to 90%3 of carotid stents are now being placed in asymptomatic patients. We believe the increase in carotid stenting procedures at the expense of CEA, as well as the number of asymptomatic patients treated, to be concerning for several reasons.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();