Category
Applied
Description
Background: Contemporary carotid revascularization includes carotid endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and transcarotid artery revascularization (TCAR), but current patient distribution across these procedures is not well described in the VQI carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedural datasets.
Methods: We performed a retrospective descriptive study using the VQI carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedural datasets from 2016 through 2023. Included patients were adults aged =18 years with Medicare coded as the primary insurer who underwent elective asymptomatic carotid revascularization and survived to discharge. TF-CAS was defined by transfemoral access with distal embolic protection, and TCAR was defined by transcarotid access with flow reversal.
Results: The cohort included 48,323 procedures: 34,909 CEA, 3,169 TF-CAS, and 10,245 TCAR. Most patients were aged 65 to 84 years (88.1%), male (59.8%), and White (90.8%). TCAR represented 0.6% of annual carotid revascularization volume in 2016, 35.3% in 2022, and 39.0% in 2023. Observed in-hospital neurologic event rates were 0.9% for CEA, 1.5% for TF-CAS, and 0.9% for TCAR; myocardial infarction rates were 0.6%, 0.3%, and 0.4%, respectively.
Conclusions: In the VQI carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedural datasets, CEA remained the most common carotid revascularization procedure, whereas TCAR accounted for an increasing share over time. Future work will evaluate total reimbursement for the index hospitalization and 90-day costs after linked VISION-Medicare payment files become available.
Keywords: Carotid endarterectomy (CEA); Transfemoral carotid artery stenting (TF-CAS); Transcarotid artery revascularization (TCAR); VQI; Medicare reimbursement
Comparative Analysis of Medicare Reimbursement for Carotid Endarterectomy, Transfemoral Carotid Artery Stenting, and Transcarotid Artery Revascularization Among Asymptomatic Patients.
Applied
Background: Contemporary carotid revascularization includes carotid endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and transcarotid artery revascularization (TCAR), but current patient distribution across these procedures is not well described in the VQI carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedural datasets.
Methods: We performed a retrospective descriptive study using the VQI carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedural datasets from 2016 through 2023. Included patients were adults aged =18 years with Medicare coded as the primary insurer who underwent elective asymptomatic carotid revascularization and survived to discharge. TF-CAS was defined by transfemoral access with distal embolic protection, and TCAR was defined by transcarotid access with flow reversal.
Results: The cohort included 48,323 procedures: 34,909 CEA, 3,169 TF-CAS, and 10,245 TCAR. Most patients were aged 65 to 84 years (88.1%), male (59.8%), and White (90.8%). TCAR represented 0.6% of annual carotid revascularization volume in 2016, 35.3% in 2022, and 39.0% in 2023. Observed in-hospital neurologic event rates were 0.9% for CEA, 1.5% for TF-CAS, and 0.9% for TCAR; myocardial infarction rates were 0.6%, 0.3%, and 0.4%, respectively.
Conclusions: In the VQI carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedural datasets, CEA remained the most common carotid revascularization procedure, whereas TCAR accounted for an increasing share over time. Future work will evaluate total reimbursement for the index hospitalization and 90-day costs after linked VISION-Medicare payment files become available.
Keywords: Carotid endarterectomy (CEA); Transfemoral carotid artery stenting (TF-CAS); Transcarotid artery revascularization (TCAR); VQI; Medicare reimbursement
