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Michel Makaroun, M.D.
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Tudor Jovin, M.D.
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UPMC Approved to Offer Carotid Stenting to Medicare Recipients

PITTSBURGH, May 23, 2004 Certain elderly patients on Medicare can now have carotid stenting performed at the University of Pittsburgh Medical Center (UPMC), which has been approved by the Centers for Medicare & Medicaid Services (CMS) for reimbursement for carotid artery stenting for symptomatic patients who are at high risk for carotid surgery, also known as carotid endarterectomy.

Endarterectomy is a surgical procedure used to prevent strokes in which the surgeon removes fatty deposits or plaques from the carotid arteries, the two main arteries in the neck that supply blood to the brain. When the arteries become narrowed by plaque, blood flow to the brain is reduced, increasing the risk of stroke, which can lead to substantial morbidity, mortality and long-term disability. Carotid endarterectomy is a very effective procedure to prevent stroke but some patients are at high risk from a surgical intervention.

Stenting is a less invasive and potentially safer procedure for high-risk patients in which a catheter is used to place a stent in the carotid artery in order to open and widen the narrowed artery. In the stent procedure, a small flexible catheter with a metallic stent positioned at the end is placed in the narrowed region of the carotid artery. The stent, when deployed, expands and compresses the plaque against the blood vessel wall, thereby enlarging the opening in the carotid artery and maintaining blood flow to the brain. When the catheter is removed, the stent remains in place as a fixed scaffold to keep the artery open.

UPMC is approved to perform the procedure at UPMC Presbyterian and UPMC Shadyside.

Carotid stenting has actually been in evolution for the past 10 years and we have been deeply involved in essentially all of the clinical trials that established both efficacy and safety for carotid stenting as an alternative to surgical endarterectomy, said Mark Wholey, M.D., chairman, Pittsburgh Vascular Institute at UPMC Shadyside. Certainly the high-risk trials that we have participated in all validate that carotid stenting in this surgical subset of patients is at least the equivalent and, in certain situations, somewhat more desirable that the previous gold standard of surgical carotid endarterectomy.

For patients who are at high risk for surgery, carotid stenting now provides a good alternative to treat their disease and reduce their risk of stroke. It is a major step forward in how we treat this problem in patients who cannot have surgery, said Michel Makaroun, M.D., professor and chief of the division of vascular surgery at UPMC.

Dr. Makaroun, in addition to Dr. Wholey will perform carotid stenting at UPMC Shadyside. Dr. Makaroun, Michael Horowitz, M.D., associate professor of neurological surgery and radiology at the University of Pittsburgh School of Medicine, and Tudor Jovin, M.D., assistant professor of neurology will perform the procedure at UPMC Presbyterian.

In order for patients to be eligible for coverage by Medicare, they must be at high risk for carotid surgery, and have symptomatic carotid artery stenosis exceeding 50 percent narrowing. Outside of these limitations, patients can still have carotid stenting at UPMC with insurance coverage and/or Medicare coverage if they join one of many trials approved by the FDA and CMS and currently running at UPMC.

Medicare is limiting use of carotid stenting to facilities and physicians who have been determined to be competent in performing the evaluation, procedure and necessary follow-up care, according to CMS. Competency is based on published clinical guidelines that outline physician training and facility support requirements for carotid artery stenting.

Stroke kills nearly 163,000 people a year in the United States, accounting for about one of every 15 deaths. Annually, some 700,000 people in the U.S. have a new or recurrent stroke. More than 70 percent of stroke victims are over 65 years of age and are, therefore, eligible for Medicare.

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