Related Experiment Video

Updated: Feb 15, 2026

Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome
06:04

Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome

Published on: September 27, 2024

1.6K

Association between Medicare high-risk criteria and outcomes after carotid revascularization procedures

Caitlin W Hicks1, Besma Nejim1, Satinderjit Locham1

  • 1Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.

Journal of Vascular Surgery
|January 24, 2018
PubMed

Insights

The Centers for Medicare and Medicaid Services (CMS) high-risk criteria for carotid artery stenting (CAS) may overestimate benefits in high-risk patients and underappreciate utility in normal-risk patients. Re-evaluation of these criteria and national guidelines for CAS indications is needed.

Area of Science:

  • Vascular Surgery
  • Health Services Research
  • Clinical Trial Analysis

Background:

  • The Centers for Medicare and Medicaid Services (CMS) established high-risk criteria for carotid artery stenting (CAS).
  • These criteria have not undergone validation to assess their accuracy in patient selection.
  • This study validates the CMS high-risk criteria in a large, national cohort.

Purpose of the Study:

  • To validate the CMS high-risk criteria for patient selection in carotid revascularization procedures.
  • To compare stroke outcomes between CAS and carotid endarterectomy (CEA) in normal-risk and high-risk patient groups.
  • To inform national guidelines regarding the indications for CAS.

Main Methods:

  • Utilized the Vascular Quality Initiative (VQI) database from 2013-2016.
  • Included patients undergoing CAS (with embolic protection) or CEA.
  • Stratified patients into normal-risk (Nr) and high-risk (Hr) groups based on CMS criteria and used matching techniques for outcome comparison.

Main Results:

  • A total of 51,942 patients were analyzed (CAS: 7030, CEA: 44,912).
  • Crude analysis showed higher 30-day and 2-year stroke rates for CAS versus CEA in both Nr and Hr groups.
  • After matching, stroke risk remained higher for CAS in the Hr group, but was similar between CAS and CEA in the Nr group.

Conclusions:

  • The CMS criteria may overestimate the benefit of CAS in high-risk patients.
  • The utility of CAS in normal-risk patients might be underestimated.
  • Re-evaluation of CMS high-risk criteria and national guidelines for CAS indications is recommended.
Abstract

More Related Videos

Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction14:19

Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction

Published on: October 14, 2016

12.1K
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale19:15

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

Published on: August 25, 2014

88.1K

Related Concept Videos

Criteria for Causality: Bradford Hill Criteria - II01:28

Criteria for Causality: Bradford Hill Criteria - II

The Bradford Hill criteria serve as guidelines for establishing causative links in epidemiological research. Beyond Strength, Consistency, Specificity, and Temporality, key criteria also include Biological Gradient, Plausibility, Coherence, Experiment, and Analogy. These principles assist scientists in assessing the likelihood of causation in complex biological contexts. Below is a summary of these concepts:
1.3K
Criteria for Causality: Bradford Hill Criteria - I01:30

Criteria for Causality: Bradford Hill Criteria - I

The Bradford Hill criteria are a group of principles that provide a framework to determine a causal relationship between a specific factor and a disease. There are nine criteria that are pivotal in assessing causality in epidemiological studies. Here's a closer look at Strength, Consistency, Specificity, and Temporality criteria with definitions and examples:
1.2K
Predicting Reaction Outcomes02:24

Predicting Reaction Outcomes

Kinetics describes the rate and path by which a reaction occurs. In contrast, thermodynamics deals with state functions and describes the properties, behavior, and components of a system. It is not concerned with the path taken by the process and cannot address the rate at which a reaction occurs. Although it does provide information about what can happen during a reaction process, it does not describe the detailed steps of what appears on an atomic or a molecular level. On the other hand,...
11.0K
Relative Risk01:12

Relative Risk

Relative risk (RR) is a statistical measure commonly used in epidemiology to compare the likelihood of a particular event occurring between two groups. This metric is important for evaluating the relationship between exposure to a specific risk factor and the probability of a particular outcome. It plays a crucial role in medical research, public health studies, and risk assessment. Relative risk quantifies how much more (or less) likely an event is to occur in an exposed group compared to an...
2.2K
Outcomes of Glycolysis01:13

Outcomes of Glycolysis

Nearly all the energy used by cells comes from the bonds that make up complex organic compounds. These organic compounds are broken down into simpler molecules, such as glucose. As a result, cells extract energy from glucose over many chemical reactions—a process called cellular respiration.
Cellular respiration can occur aerobically (with oxygen) or anaerobically (without oxygen). In the presence of oxygen, cellular respiration starts with glycolysis and continues with pyruvate...
107.8K
Associative Learning01:27

Associative Learning

Associative learning is a fundamental concept in behavioral psychology, wherein a connection is established between two stimuli or events, leading to a learned response. This process is critical in understanding how behaviors are acquired and modified. Conditioning, the mechanism through which associations are formed, can be divided into two main types: classical conditioning and operant conditioning, each elucidating different aspects of associative learning.
Classical conditioning, also known...
1.5K