Advanced Technology: Carotid Angioplasty and Stenting
A stent is a tiny wire mesh tube used to open an artery. In cariod angioplasty and stenting (CAS), the stent is placed in the blocked artery during angioplasty, and keeps the artery open. While some restrictions remain on the use of CAS, the procedure is being performed more widely in recent years. CAS is minimally invasive and studies have shown it to be as effective as CEA for the treatment of carotid stenosis (occlusion of the carotid artery, an artery in the neck which carries blood to the brain), particularly in patients who are at high risk for surgical treatment (Stroke, April 2002: 33(4); 1063-1070 ).
Brigham and Women's Hospital offers carotid angioplasty and stenting for the treatment of carotid stenosis.
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Annual CEA Procedure Volume
The number of surgeries a hospital or surgeon performs is easily measured and has been used to denote clinical expertise. Procedure volume (number of cases performed) has therefore become a widely-used quality indicator for surgical procedures. According to the Agency for Healthcare Research and Quality (AHRQ), a higher volume of carotid endarterectomy cases is associated with lower mortality and complication rates. Lower-volume facilities with well-trained surgeons may also achieve excellent clinical outcomes; however, the odds favor patients who are treated in hospitals with a higher number of procedures.
Brigham and Women's Hospital’s vascular surgeons performed 86 carotid endarterectomy (CEA) procedures in the 12-month period ending 6/30/08. An additional 19 were performed by BWH neurosurgeons.
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Annual CEA Volume by Surgeon
It has been suggested that the volume of procedures performed by an individual surgeon, rather than the hospital as a whole, may have more impact on the outcomes of CEA procedures (Journal of the American College of Surgeons, December 2002: 195(6); 814-821). While there has been no guideline set for the number of CEA's a surgeon should perform to maintain quality, studies suggest that at least 10 procedures per year should be performed to maintain competence (American Journal of Surgery, May 2001: 181(5); 450-453).
In 2007-2008 (Jul '07-Jun '08), 92% of the CEA procedures performed by Brigham and Women's Hospital's vascular surgeons were done by surgeons who did at least 10 CEA procedures that year. Surgeries in which CEA was not the primary procedure were excluded from this measure due to data complications.
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Inpatient Mortality
Mortality rate (measured as a percentage) provides general information about the quality of care delivery, and can be an important quality indicator. However, some hospitals care for patients with a greater severity of illness and therefore may have a higher mortality rate. Based on a large sample of university hospitals (data from the University Healthsystem Consortium, aka UHC), the national average mortality rate for CEA is 0.58%. Because BWH patients are generally more sick than the average patient, our expected mortality rate for CEA is 0.92% (as estimated by UHC).
The inpatient mortality rate for CEA at Brigham and Women's Hospital is 0.89%, which is not significantly different than both the national observed and expected rates. All rates refer to the 12-month period ending 6/30/08.
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30-Day All Causes Mortality Rate for CEA
The "30-Day All Causes" mortality rate measures how well patients do both in and out of the hospitals. Patient deaths from any cause (within 30 days after surgery) are included in this rate. When looking at mortality rates, it is important to remember that some hospitals care for sicker-than-average patients. Patients with CEA often have heart disease, so short and long term survival reflects not only the quality of surgical care, but also the quality of the overall medical care received.
The 30-day all causes mortality rate for CEA at Brigham and Women's Hospital was 0% in the 12-month period ending 6/30/08. No national average is available.
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30-Day Non-Fatal Stroke Rate for CEA
The 30-day non-fatal stroke rate includes all strokes occurring within 30 days of the CEA procedure. Strokes from any cause are included, and they may or may not be related to the CEA procedure. This measure includes only non-fatal strokes, because fatal strokes are included in the previous measure.
The 30-day non-fatal stroke rate for CEA at Brigham and Women's Hospital was 0% in the 12-month period ending 6/30/08. No national average is available.
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Vascular Laboratory Accreditation
Today's health care organizations are held to very high levels of accountability - by peers, by the general public, and by Medicare and other payers. The Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) accreditation is a means by which noninvasive vascular laboratories can evaluate and demonstrate the level of patient care they provide.
Brigham and Women's Hospital’s Vascular Laboratory is ICAVL accredited. Please click here to go to the BWH Vascular Diagnostic Laboratory website.
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