Medicare High Risk Criteria in Carotid Stenting

Medicare High Risk Criteria in Carotid Stenting

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.




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