Expert consensus on carotid stenting

Stenting the carotid arteries is "a reasonable alternative" to gold-standard carotid endarterectomy in patients at high risk for surgery, according to a clinical expert consensus document published in the Jan. 2/9 Journal of the American College of Cardiology. However, there is insufficient evidence to support carotid stenting in high-risk patients with "asymptomatic stenosis less than 80% or in any patient without high-risk features." CMS likely will consider the consensus when it proposes a revised coverage decision for carotid stenting Feb. 2. Abbott/Guidant requested expanded coverage for all high-risk patients with symptomatic stenosis greater than 50% or asymptomatic stenosis greater than 80% (1"The Gray Sheet" Sept. 11, 2006, p. 6). Currently, Medicare covers symptomatic, high-risk patients with greater than 70% stenosis. Those patients with symptomatic stenosis between 50% and 70% or asymptomatic stenosis greater than 80% are covered only in FDA-approved studies. The consensus document was produced by five professional societies...