Dr. Nick Osborne presented, "Examining the Effect of the National Coverage Determination on Carotid Procedures in the State of Michigan," during VAM 2026

Dr. Osborne stands at the podium on the #VAM2026 stage. He's wearing a blue suit and his image is projected on a giant screen behind him.
|
BMC2 Coordinating Center

Dr. Nick Osborne presented, "Examining the Effect of the National Coverage Determination on Carotid Procedures in the State of Michigan," during VAM 2026 in Boston on June 11th, 2026.

Carotid artery stenosis is a life-threatening disease that frequently causes stroke. Treatment options for this disease include carotid endarterectomy (CEA), Transfemoral Carotid Artery Stenting (TfCAS), and Transcarotid Artery Revascularization (TCAR). The Centers for Medicare and Medicaid Services (CMS) released a national coverage determination (NCD) in 2023 that revised the criteria for performing both TfCAS and TCAR (carotid stenting procedures) for asymptomatic carotid artery stenosis. Importantly, this NCD expanded the use of carotid artery stenting for patients with >70% asymptomatic carotid stenosis (a patient group previously not covered by the CMS). Using the BMC2 data spanning 2019 to 2025, the investigators examined how this expanded coverage affected the rates of carotid artery procedures across the state of Michigan.  

During this time, a total of 17,239 patients underwent a carotid artery revascularization, including 12,591 in the Pre-NCD group and 4,648 in the Post-NCD group. Prior to the NCD, transfemoral stenting was decreasing in frequency across hospitals. Following the NCD, there was a clear increase in TfCAS procedures (change in slope +3.66, p=0.038). In comparison, there were no significant changes in the rates of asymptomatic TCAR volumes (change in slope -6.04, p=0.072) and asymptomatic CEA (change in slope -3.03, p=0.629).  

Importantly, following the NCD, there was a significant increase in the rate of major adverse cardiovascular events (MACE) at one year following all procedures (11% pre-policy, 15.3% post-policy, p< 0.001). This increased MACE remained significant after controlling for patient and hospital factors. 
 
The authors concluded that the CMS NCD was associated with a significant increase in the rate of transfemoral stenting procedures compared to no significant changes among other carotid procedures performed for asymptomatic disease.  

Publication authors are Jonathan Cunha, MD, MS; Craig Brown, MD, MS; Jeremy Albright, PhD; Peter Henke, MD; and Nicholas Osborne, MD, MS. 

Learn more on the VAM website.