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Staying Safer After Carotid Stenting

September 27th, 2011

Results of a study just published in the Journal of the American Medical Association (JAMA) suggest guidelines for patients that could help keep them safer after carotid stenting. In fact, this advice might even save lives.

A stent is a tiny tube that acts to keep an artery open, allowing blood to flow properly. Stents are most commonly used to treat blocked arteries around the heart to prevent heart attack, but a newer procedure — carotid stenting — uses stents in the internal carotid artery (which rises to the brain through the neck) to prevent strokes.  This is significant because approximately 10% to 15% of ischemic strokes are due to atherosclerosis of the internal carotid artery. Since 2004 when the first carotid stent was placed, the use of this medical procedure has more than doubled in Medicare beneficiaries.

Unfortunately, carotid stenting is quite a demanding procedure that requires a great deal of technical skill on the part of the surgeon. Researchers from the University of Michigan and numerous other medical institutions examined whether a surgeon’s experience performing carotid stenting had any effect on outcomes for patients. Data came from nearly 25,000 patients and about 2300 operators who performed the surgeries between January 1, 2005, and December 31, 2007.

The results show that experience makes a big difference. I’ll even go out on a non-scientific limb and say:  Experience makes a ginormous difference… and it is news you can actually use.

Study Results

The researchers categorized operators into 4 groups:

  • Very low experience:  performing fewer than 6 carotid stent procedures per year;
  • Low experience:  performing 6 to 11 procedures per year;
  • Medium experience:  performing 12 to 23 procedures per year;
  • High experience:  performing 24 or more procedures per year.

They found that patients treated by operators with “Very Low” experience were nearly twice as likely to die within 30 days as those treated by operators with “High” experience. In addition–not surprisingly–patients who were treated by operators who were just beginning their experience faired worse than those who had more overall experience. For example, patients receiving one of an operator’s first 10 surgeries were about 70% more likely to die within 30 days than patients who received an operator’s 12th or or higher surgery.

It’s important to note that the overall 30-day death rate was only about 2%. So the differences we’re talking about here in raw numbers is small. Still, most people would like the option of reducing their risk of death after a procedure. In this case, the “fix” is simple:  When you talk with a potential surgeon before a carotid stenting, ask how many procedures he or she has performed in total… and how many procedures he or she performs each year.  Look for an operator who has performed more than 12 procedures overall, and—if possible—performs at least 24 procedures annually.

If you have an option, remember that “more is better,” and choose the most experienced operator possible.

RESOURCES

Article citation:

Nallamothu BK, Gurm HS, et al. Operator Experience and Carotid Stenting Outcomes in Medicare Beneficiaries. JAMA. 2011; 306(12):1338-1343.

To read a summary of of the JAMA article, click here:  JAMA abstract