Abstract Details

Title Creating Accountable Care for Carotid Angioplasty and Stenting Lessons Learned from a Multidisciplinary Carotid Revascularization Board

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) (-)

Poster/Presentation
Number 004

Objective

Background Carotid angioplasty and stenting (CAS) has emerged as a potentially less invasive alternative to CEA. Based on the results of SAPPHIRE published in 2004, the Food and Drug Administration (FDA) approved the use of CAS with protection device in certain patients at high surgical risk for CEA.

Design/Methods The board was composed of vascular surgeons, cardiologists, interventional neuroradiologists, neurosurgeons, and neurologists, who met weekly to facilitate an evidence-based, consensus recommendation to ensure appropriate CAS referral.

Results 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 Multidisciplinary approach provides a quality control element, facilitates an evidence based approach and improves collaboration and consensus in this evolving field. We feel that our MDCB overestimated the life expectancy, under estimated the clinical relevance of angiographic high risk features, did not realize the full potential of maximal medical management and frequently was too aggressive in recommending CAS in these high-risk surgical patients.

Authors/Disclosures
Muhib Khan, MD, FAAN (Mayo Clinic) PRESENTER	The institution of Dr. Khan has received research support from Mayo Clinic ��ɫ�� Grant . The institution of Dr. Khan has received research support from Mayo Clinic Small Grants .
Jai Perumal, MD	Dr. Perumal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Perumal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for T G therapeutics. Dr. Perumal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono.
	No disclosure on file

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