Medicare Data Shows Rising CAS Use but No Shift Away from CEA Post-CMS Coverage Expansion

A study analyzing Medicare data from 2017 to 2024 examined the use of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) following the 2023 CMS expansion of CAS coverage to include more standard-risk patients. Findings indicate no significant shift favoring CAS over CEA despite increased CAS utilization from 13% to 37.5% overall. The study highlights a growing role of vascular surgeons in performing these procedures, accounting for an increased share from 46% to 55%. CAS procedures are mainly conducted by vascular surgeons, cardiologists, and interventional radiologists, while CEA remains prevalent among vascular, cardiothoracic, and general surgeons. The study also underscores challenges in implementing CMS-required shared decision-making given that many physicians do not offer both procedures, which has implications for compliance and patient care strategies in vascular interventions.