A Comparison of Clinical Outcomes From Carotid Artery Stenting Among US Hospitals

My doctors at the hospital never found that my right carotid artery was about 80% blocked at time of stroke. The dissection of that artery and subsequent throwing of a clot caused my stroke. Incompetence in all its glory. It is now completely closed up, wonderful news that is.  I most certainly do not need that artery for my mental or physical abilities. You doctor needs to explain Circle of Willis to you and themselves.
Will your doctor inform you of these other possibilities for treating plaque in your arteries?
1.  Treatments for clogged arteries - lawnmower, drano or conventional?  
2.  Watermelon juice reverses hardening of the arteries
3.   http://oc1dean.blogspot.com/2011/08/beets-brain-health.html

4.  New artery blockage treatment may be in the offing

As someone from the medical profession mentioned to me once, 'Why would you consider putting inflexible metal items in flexible blood vessels?'

The comparison here:

http://circoutcomes.ahajournals.org/content/early/2014/06/03/CIRCOUTCOMES.113.000819.abstract

1. Andrew J. Epstein, PhD,
2. Lin Yang, MS,
3. Feifei Yang, MS and
4. Peter W. Groeneveld, MD, MS

+ Author Affiliations

1. From the Department of Veterans Affairs’ Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, PA (A.J.E., P.W.G.); Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (A.J.E., L.Y., F.Y., P.W.G.); and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (A.J.E., P.W.G.).

1. Correspondence to Peter W. Groeneveld, MD, MS, Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 1229 Blockley Hall, 423 Service Dr, Philadelphia, PA 19104-4155. E-mail petergro@upenn.edu

Abstract

Background—The Centers for Medicare and Medicaid Services require hospitals performing carotid artery stenting (CAS) to recertify the quality of their programs every 2 years, but currently this involves no explicit comparisons of postprocedure mortality across hospitals. Hence, the current recertification process may fail to identify hospitals that are performing poorly in relation to peer institutions. Our objective was to compare risk-standardized procedural outcomes across US hospitals that performed CAS and to identify hospitals with statistically high postprocedure mortality rates.

Methods and Results—We conducted a retrospective cohort study of Medicare beneficiaries who underwent CAS from July 2009 to June 2011 at 927 US hospitals. Thirty-day risk-standardized mortality rates were calculated using the Hospital Compare statistical method, a well-validated hierarchical generalized linear model that included both patient-level and hospital-level predictors. Claims were examined from 22 708 patients undergoing CAS, with a crude 30-day mortality rate of 2.0%. Risk-standardized 30-day mortality rates after CAS varied from 1.1% to 5.1% (P<0.001 for the difference). Thirteen hospitals had risk-standardized mortality rates that were statistically (P<0.05) higher than the national mean. Conversely, 5 hospitals had risk-standardized mortality rates that were statistically (P<0.05) lower than the national mean.

Conclusions—We used administrative claims to identify several CAS hospitals with excessively high 30-day mortality after carotid stenting. When combined with information currently used by Medicare for CAS recertification, such as clinical registry data and program reports, clinical outcomes comparisons could enhance Medicare’s ability to identify hospitals that are questionable candidates for recertification.