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BMC2 Coordinating Center
Judith Lin, MD, MBA, presented the poster “Management of Asymptomatic Carotid Artery Disease across Michigan Cardiovascular Consortium” during the Society for Vascular Surgery’s Vascular Annual Meeting, June 10 - 13, 2026, in Boston.
Despite guideline development for the management of ACS, significant variability in clinical practice persists across institutions and regions.
Dr. Lin and co-authors utilized data from the BMC2 peer review process to assess the appropriateness and patterns of carotid endarterectomy (CEA) for asymptomatic carotid stenosis (ACS) across BMC2-participating hospitals
The team reviewed charts for CEAs for ACS conducted between January 1, 2019, and November 18, 2023. Up to six cases per site were selected for peer review, excluding those involving concurrent CABG.
Data sources included preoperative history and physicals, imaging, medication records, and operative reports. Imaging type and stenosis estimates were standardized for analysis.
Two external vascular surgeons reviewed each case. A third reviewer resolved discrepancies.
Appropriateness was assessed based on guideline criteria, and descriptive statistics were used to summarize findings.
A total of 335 CEA cases were reviewed. Preoperative imaging was performed in 99.4% of cases, with carotid duplex (82.5%) and CTA (72.4%) being the most common. Documented stenosis was present in 98.2% of cases, with 32.2% showing ≥90% stenosis and 37.2% showing 70–79% stenosis.
Peer review found 91.3% of cases met criteria for repair, while 3.9% did not meet guideline-recommended thresholds. Among these, some were justified by rapid disease progression or high-risk comorbidities.
Completion imaging post-CEA was performed in 64.8% of cases. Regarding medical therapy, 87.2% received antiplatelet agents and 80.9% received statins. Protamine reversal was documented in 60% of cases.
This multicenter review highlights substantial adherence to guideline-based care in the surgical management of ACS, with most CEAs deemed appropriate. However, variability in imaging, documentation, and perioperative practices persists.
Continued peer review and data sharing within collaboratives like BMC2 may enhance consistency, reduce unnecessary procedures, and improve patient outcomes in ACS management.
Co-authors are Evan Guay, PhD, DO; Sung Heum Jo, DO; Nicholas H. Osborne, MD, MS; Jeremy Albright, PhD; and Mollie Bodin, MA.