October 5, 2023
What does Medicare consider high risk to support a stent instead of a carotid endarterectomy (CEA)?
Patients at high risk for CEA are defined as having significant comorbidities and/or anatomic risk factors (i.e., recurrent stenosis and/or previous radical neck dissection) and would be poor candidates for CEA in the opinion of a surgeon. Significant comorbid conditions include but are not limited to:
- congestive heart failure (CHF) class III/IV;
- left ventricular ejection fraction (LVEF) < 30%;
- unstable angina.
- contralateral carotid occlusion;
- recent myocardial infarction (MI);
- previous CEA with recurrent stenosis ;
- prior radiation treatment to the neck; and
- other conditions that were used to determine patients at high risk for CEA in the prior carotid artery stenting trials and studies, such as ARCHER, CABERNET, SAPPHIRE, BEACH, and MAVERIC
*This response is based on the best information available as of 10/5/23.