Title

Institutional differences in carotid artery duplex diagnostic criteria result in significant variability in classification of carotid artery stenoses and likely lead to disparities in care

UMMS Affiliation

Department of Surgery

Date

5-1-2014

Document Type

Article

Disciplines

Cardiovascular Diseases | Surgery

Abstract

BACKGROUND: The indications for carotid revascularization are based almost exclusively on the results of carotid duplex ultrasonography. Noninvasive vascular laboratories show large variation in the diagnostic criteria used to classify degree of carotid artery stenosis. We hypothesize that variability of these diagnostic criteria causes significant variation in stenosis classification directly affecting the number of revascularizations and associated costs.

METHODS AND RESULTS: The diagnostic criteria to interpret carotid duplex ultrasounds were obtained from 10 New England institutions. All carotid duplex scans performed at our institution were reviewed from 2008 to 2012. Using the diagnostic criteria from each institution, the degree of stenosis that would have been reported was classified as 70% to 99% asymptomatic, 80% to 99% asymptomatic, and 50% to 99% symptomatic. We then calculated the theoretical number of carotid revascularization procedures that this cohort would be offered using each institution's diagnostic criteria and the costs of these procedures based on reimbursement rates. Among 10614 patients who underwent 15534 carotid duplex scans, 31025 arteries were reviewed. Application of the 10 institutions' criteria to the patients from our institution yielded marked variation in the number classified as 70% to 99% asymptomatic (range, 186-2201), 80% to 99% asymptomatic (range, 78-426), and 50% to 99% symptomatic (range, 157-781). If revascularizations were based on these results, costs would range from $2.2 to $26 million, $0.9 to $5.0 million, and $1.9 to $9.2 million, respectively.

CONCLUSIONS: Differences in diagnostic criteria to interpret carotid ultrasound result in significant variation in classification of carotid artery stenosis, likely leading to differences in the number and subsequent costs of revascularizations. This theoretical model highlights the need for standardization of carotid duplex criteria.

Rights and Permissions

Citation: Circ Cardiovasc Qual Outcomes. 2014 May;7(3):423-9. doi: 10.1161/CIRCOUTCOMES.113.000855. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Keywords

carotid arteries, carotid stenosis, carotid endarterectomy

PubMed ID

24737405