Implications of the Centers for Medicare and Medicaid Services (CMS) decision to expand indications for carotid artery stenting

Kosmas I Paraskevas; Clark J Zeebregts; Ali F AbuRahma; Bruce A Perler

doi:10.1016/j.jvs.2024.03.008

Implications of the Centers for Medicare and Medicaid Services (CMS) decision to expand indications for carotid artery stenting

J Vasc Surg. 2024 Mar 8:S0741-5214(24)00425-7. doi: 10.1016/j.jvs.2024.03.008. Online ahead of print.

Authors

Kosmas I Paraskevas¹, Clark J Zeebregts², Ali F AbuRahma³, Bruce A Perler⁴

Affiliations

¹ Department of Vascular Surgery, Red Cross Hospital, Athens, Greece. Electronic address: paraskevask@hotmail.com.
² Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Surgery, Charleston Area Medical Center/West Virginia University, Charleston, WV.
⁴ Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.

PMID: 38462061
DOI: 10.1016/j.jvs.2024.03.008

Abstract

Objective: On October 11, 2023, the Centers for Medicare and Medicaid Services (CMS) expanded the indications for carotid artery stenting (CAS) to include patients with ≥50% symptomatic or ≥70% asymptomatic carotid stenosis. The aim of this article was to investigate the implications of this decision.

Methods: The reasons behind the increased coverage for CAS are analyzed and discussed, as well as the various Societies supporting or opposing the expansion of indications for CAS.

Results: The benefits associated with expanding CAS indications include providing an additional therapeutic option to patients and enabling individualization of treatment according to patient-specific characteristics. The drawbacks of expanding CAS indications include a possible bias in decision-making and an increase in inappropriate CAS procedures.

Conclusions: The purpose of the CMS recommendation to expand indications for CAS is to improve the available therapeutic options for patients. Hopefully this decision will not be misinterpreted and will be used to improve patient options and patient outcomes.

Keywords: Carotid artery stenosis; Carotid artery stenting; Carotid endarterectomy.