title: Creating accountable care for carotid angioplasty and stenting: A multidisciplinary carotid revascularization board.
abstract: BACKGROUND
  We tested the feasibility of a mandated multidisciplinary carotid revascularization board (MDCB) to review, approve and monitor all carotid artery and stenting (CAS) procedures and outcomes at our institution.
  
  
  METHODS
  The board was composed of vascular surgeons, cardiologists, interventional neuroradiologists, neurosurgeons, and neurologists, who met weekly to facilitate an evidence-based, consensus recommendation to ensure appropriate CAS referral.
  
  
  RESULTS
  The board successfully reviewed and continues to review and approve all CAS procedures at our center. Of the 69 patients considered high risk for standard surgical treatment, 42 patients were symptomatic and 27 patients were asymptomatic. Their mean age was 70.5-year-old and the median degree of stenosis was 79%. In the 74 procedures, periprocedural complications occurred at the following rates: 2.7% death, 2.7% major stroke, 2.7% minor stroke, and 2.7% myocardial infarction (MI) within 30 days of the procedure. At 1 year the primary endpoints of ipsilateral stroke and neurovascular-related death were observed in 8.1% and 2.7% of the patients, respectively. At mean follow-up of 21 months, 18.8% of the patients (13/69) had died (including all causes), and 14.5% (10/69) experienced stroke (including nontarget strokes). Target vessel revascularization was needed in 2.9% patients.
  
  
  CONCLUSIONS
  A mandated multidisciplinary carotid revascularization board MDCB is feasible and potentially advantageous in real clinical practice. It establishes a model for accountable care by providing a mechanism for institutional oversight, credentialing operators, quality review, standardizing care, cost containment and eliminating the "subspecialty silo mentality."
authors: Department of Radiology and Neurosurgery, Henry Ford Hospital, Detroit, MI, USA.
authors: Maximilian K
authors: MK
authors: Kole
authors: Muhib
authors: M
authors: Khan
authors: Horia
authors: H
authors: Marin
authors: William
authors: W
authors: Sanders
authors: Alexander
authors: A
authors: Shepard
authors: Angelos M
authors: AM
authors: Katramados
authors: Andrew N
authors: AN
authors: Russman
authors: Steven
authors: S
authors: Gellman
authors: Timothy
authors: T
authors: Nypaver
authors: Ghaus
authors: G
authors: Malik
authors: Panayiotis D
authors: PD
authors: Mitsias
keywords: Carotid angioplasty; multidisciplinary review board; stenting