title: The underuse of carotid interventions in veterans with symptomatic carotid stenosis.
abstract: OBJECTIVE
  To examine the receipt of carotid intervention among eligible patients post stroke in the Veterans Health Administration (VA).
  
  
  METHODS
  We examined whether veterans admitted to a VA medical center in 2007 with a diagnosis of stroke and who were eligible for intervention, received carotid intervention in a period up to 6 months after their index hospitalization. We also examined whether demographics, comorbid conditions, stroke severity and availability of vascular intervention services were independently associated with receipt of intervention.
  
  
  RESULTS
  Among the 5721 patients admitted, 253 ischemic stroke patients had evidence of some carotid stenosis and had data on side of stroke available. Among the 200 patients who had at least 50% to 99% stenosis of the carotid artery, 34 (17%) received intervention (95% confidence interval [CI], 11.79%-22.21%). In a multivariable model, black race and past history of diabetes were significantly associated with carotid intervention: An eligible black patient was 6 times more likely to NOT receive intervention compared to patients of other races (adjusted odds ratio [OR] = 6.54; 95% CI, 1.34-31.9), and a patient with diabetes was 3 times more likely to NOT receive intervention (adjusted OR = 3.38; 95% CI, 1.24- 9.24) compared to non-diabetics. Stroke severity and availability of vascular surgery services was not associated with receipt of intervention.
  
  
  CONCLUSIONS
  Few patients with symptomatic carotid stenosis who were admitted with stroke to the VA received carotid intervention. Future research should be directed at improving access to this procedure among eligible patients in the VA.
authors.affiliation: San Francisco VA Medical Center, 4150 Clement St (111A1), San Francisco, CA 94121. E-mail: salomeh.keyhani@ucsf.edu.
authors.forename: Salomeh
authors.initials: S
authors.lastname: Keyhani
authors.forename: Eric
authors.initials: E
authors.lastname: Cheng
authors.forename: Susan
authors.initials: S
authors.lastname: Ofner
authors.forename: Linda
authors.initials: L
authors.lastname: Williams
authors.forename: Dawn
authors.initials: D
authors.lastname: Bravata
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D016893:Carotid Stenosis / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data