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Impact of digital subtraction angiography on carotid evaluation
Insights
Digital subtraction angiography by intravenous injection (DSAV) reduced traditional noninvasive tests and conventional arteriograms for threatened stroke evaluations. While DSAV impacts costs, its effect on evaluation quality requires further consideration.
Area of Science:
- Neurology
- Radiology
- Medical Economics
Background:
- Traditional diagnostic pathways for threatened stroke involve noninvasive tests and conventional arteriograms.
- Digital subtraction angiography by intravenous injection (DSAV) offers a potential alternative or adjunct in stroke evaluation.
Purpose of the Study:
- To examine the impact of introducing DSAV in a private neurology clinic setting.
- To assess changes in the utilization of other diagnostic modalities and associated costs following DSAV implementation.
Main Methods:
- Retrospective analysis of patient data before and after DSAV introduction.
- Tracking the use of noninvasive tests, conventional arteriograms, and DSAV for threatened stroke evaluations.
- Analysis of average evaluation costs for medically treated and surgically treated patients.
Main Results:
- DSAV introduction was associated with a significant decrease in the use of traditional noninvasive tests (100% to 36%) and conventional arteriograms (29% to 4%).
- Noninvasive tests were used for less compelling indications, while DSAV was the initial choice for more severe symptoms.
- Conventional arteriograms were reserved for cases with compelling indications and inadequate DSAV results.
- Average evaluation costs slightly increased for medically treated patients but significantly decreased for surgically treated patients.
Conclusions:
- DSAV implementation significantly altered diagnostic workflows for threatened stroke, reducing reliance on older methods.
- The adoption of DSAV shows potential for cost savings, particularly in patients undergoing surgery.
- Further investigation is needed to address the quality of evaluation concerns associated with DSAV utilization.
Abstract:
Impact of digital subtraction angiography by intravenous injection (DSAV) was examined in a private neurology clinic. In the evaluation of threatened stroke, advent of DSAV was associated with reduced use of both traditional noninvasive tests (from 100% of patients to 36%), and conventional arteriograms (from 29% to 4%). Less compelling indications were often prescreened with noninvasive tests; more compelling symptoms usually had initial DSAV. Conventional arteriograms were done for compelling indications and negative or inadequate DSAV. The average cost of evaluation was increased slightly in patients treated medically and reduced greatly in those having surgery. While cost and convenience might support such utilization, issues of quality of evaluation require consideration.