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Abstract Details

Creating Accountable Care for Carotid Angioplasty and Stenting: A Multidisciplinary Carotid Revascularization Board
Interventional Neurology
P07 - (-)
253
BACKGROUND: Since CAS was proposed as an alternative to carotid endarterectomy (CEA) in patients considered at high risk for CEA, the number of CAS procedures has steadily increased. Physicians from several specialties have been performing CAS procedures with variable, not always encouraging, results.
DESIGN/METHODS: The MDCB was composed of vascular surgeons, cardiologists, interventional neuroradiologists, neurosurgeons, and vascular neurologists, who met weekly to facilitate an evidence-based, consensus recommendation to ensure appropriate CAS referral. Institutional administration gave full approval and mandated that no CAS procedure will performed without the board's approval.
RESULTS: The MBCB successfully reviewed and continues to review and approve all CAS procedures at our center. Of the 69 patients considered high risk for standard surgical treatment, 42 patients were symptomatic and 27 patients were asymptomatic. Their mean age was 70.5 years old and the median degree of stenosis was 79%. In the 74 procedures, periprocedural complications occurred at the following rates: 2.7% death, 2.7% major stroke, 2.7% minor stroke, and 2.7 % myocardial infarction (MI) within 30 days of the procedure. At 1 year the primary endpoints of ipsilateral stroke and neurovascular-related death were observed in 8.1% and 2.7% of the patients, respectively. At mean follow-up of 21 months, 18.8% of the patients (13/69) had died (including all causes), and 14.5% (10/69) experienced stroke (including nontarget strokes). Target vessel revascularization was required in 2.9% patients.
CONCLUSIONS: A mandated multidisciplinary carotid revascularization board is feasible and potentially advantageous in real clinical practice. It establishes a model for accountable care by providing a mechanism for institutional oversight, credentialing operators, quality review, standardizing care, cost containment and eliminating the subspecialty silo mentality.
Authors/Disclosures
Panayiotis Mitsias, MD (Henry Ford Hospital, Neurology)
PRESENTER 		The institution of Dr. Mitsias has received research support from European Union.
Muhib Khan, MD, FAAN (Mayo Clinic) The institution of Dr. Khan has received research support from Mayo Clinic 好色先生 Grant . The institution of Dr. Khan has received research support from Mayo Clinic Small Grants .
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Howard L. Weiner, MD (Brigham and Women'S Hospital) Dr. Weiner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Weiner has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medday Pharmaceuticals. Dr. Weiner has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for vTv Therapeutics. Dr. Weiner has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Tiziana Life Sciences. Dr. Weiner has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for vTv Therapeutics. Dr. Weiner has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medday Pharmaceuticals. Dr. Weiner has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for vTv Therapeutics. Dr. Weiner has stock in vTv Therapeutics. The institution of Dr. Weiner has received research support from National Institute of Health. The institution of Dr. Weiner has received research support from National MS Society. The institution of Dr. Weiner has received research support from Genzyme Corp. The institution of Dr. Weiner has received research support from Genentech, Inc. . The institution of Dr. Weiner has received research support from Verily Life Sciences LLC. The institution of Dr. Weiner has received research support from EMD Serono, Inc..