Why the United States Center for Medicare and Medicaid Services (CMS) should not extend reimbursement indications for carotid artery angioplasty/stenting

Anne L. Abbott, Mark A Adelman, Andrei V Alexandrov, Henry J M Barnett, Jonathan Beard, Peter Bell, Martin Bj̈orck, David Blacker, Clifford J Buckley, Richard P Cambria, Anthony J Comerota, E. Sander Connolly, Alun H. Davies, Hans-Henning Eckstein, Rishad Faruqi, Gustav Fraedrich, Peter Gloviczki, Graeme John Hankey, Robert E Harbaugh, Eitan HeldenbergSteven J. Kittner, Timothy John Kleinig, Dimitri P Mikhailidis, Wesley S. Moore, Rebecca Naylor, Andrew Nicolaides, Kosmas Ioannis Paraskevas, David M Pelz, James W Prichard, Grant Purdie, Jean-Baptiste Ricco, Thomas Riles, Peter Malcolm W Rothwell, Peter Sandercock, Henrik Sillesen, J David Spence,, Francesco Spinelli, Aron Tan, Ankur Thapar, Frank J Veith, Wei Zhou

Research output: Contribution to journalReview ArticleOtherpeer-review

2 Citations (Scopus)


In recent years, many important discoveries have been made to challenge current policy, guidelines, and practice regarding how best to prevent stroke associated with atherosclerotic stenosis of the origin of the internal carotid artery. TheUnited States Center forMedicare andMedicaid Services (CMS), for instance, is calling for expert advice as to whether its current policies should be modified. Using a thorough review of literature, 41 leading academic stroke-prevention clinicians from the United States and other countries, have united to advise CMS not to extend current reimbursement indications for carotid angioplasty/stenting (CAS) to patients with asymptomatic carotid stenosis or to patients with symptomatic carotid stenosis considered to be at "low or standard risk from carotid endarterectomy (CEA)." It was concluded that such expansion of reimbursement indications would have disastrous health and economic consequences for the United States and any other country that may follow such inappropriate action. This was an international effort because the experts to best advise CMS are relatively few and scattered around the world. In addition, US health policy, practice, and research have tended to have strong influences on other countries.

Original languageEnglish
Pages (from-to)200-207
Number of pages8
JournalBrain and Behavior
Issue number2
Publication statusPublished - Mar 2012
Externally publishedYes


  • Carotid angioplasty
  • Carotid endarterectomy
  • Carotid stenting
  • Carotid surgery
  • Health economics
  • Public health
  • Vascular disease medical intervention

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