{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T19:37:58Z","timestamp":1793389078100,"version":"4.5.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2013,3,12]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              It is uncertain how intracranial stenting (\n              <jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content>\n              ) has been adopted nationally during a period characterized by a restrictive payment policy by the Centers for Medicare &amp; Medicaid Services, humanitarian device exemption approval by the Food and Drug Administration, and insufficient evidence of effectiveness. We sought to determine the trends in rates of\n              <jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content>\n              use and associated outcomes in the United States.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              From 65\u00a0211\u00a0328 Medicare Fee\u2010for\u2010Service beneficiaries hospitalized between 2006 and 2010 in acute care hospitals in the United States, we included patients with\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              \u20109\u2010\n              <jats:styled-content style=\"fixed-case\">CM<\/jats:styled-content>\n              procedure codes for intracranial angioplasty and stenting, excluding those with a principal discharge diagnosis code of cerebral aneurysm or subarachnoid hemorrhage. We report operative rates per 1\u00a0000\u00a0000 person\u2010years and outcomes including 30\u2010day and 1\u2010year mortality rates. There were 838\n              <jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content>\n              procedures performed among Fee\u2010for\u2010Service beneficiaries. The overall hospitalization rate for\n              <jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content>\n              increased significantly from \u22481 per 1\u00a0000\u00a0000 person\u2010years (n=35 procedures) in 2006 to 9 per 1\u00a0000\u00a0000 person\u2010years (n=258 procedures) in 2010 (\n              <jats:italic>P<\/jats:italic>\n              =0.0090 for trend). Procedure rates were higher in men than in women, and were highest among patients aged 75 to 84\u00a0years and lowest among those \u226585\u00a0years. The 30\u2010day mortality rate increased from 2.9% (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.1 to 15.3) to 12.9% (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 9.0 to 17.6),\n              <jats:italic>P<\/jats:italic>\n              =0.1294 for trend, and the 1\u2010year mortality rate increased from 14.7% (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 5.0 to 31.1) to 19.5% (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 14.9 to 24.9),\n              <jats:italic>P<\/jats:italic>\n              =0.0101; however, the annual changes were not significant after adjustment.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              <jats:styled-content style=\"fixed-case\">ICS<\/jats:styled-content>\n              utilization in the United States has modestly increased during a period of inadequate supportive evidence. Humanitarian device exemption and a restrictive payment policy appear to have caused slow adoption of the technology.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.113.000084","type":"journal-article","created":{"date-parts":[[2013,5,24]],"date-time":"2013-05-24T16:49:31Z","timestamp":1369414171000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Trends in Intracranial Stenting Among Medicare Beneficiaries in the United States, 2006\u20132010"],"prefix":"10.1161","volume":"2","author":[{"given":"Aakriti","family":"Gupta","sequence":"first","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale\u2010New Haven Hospital, New Haven, CT"},{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayur M.","family":"Desai","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale\u2010New Haven Hospital, New Haven, CT"},{"name":"Section of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT"},{"name":"Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Kim","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale\u2010New Haven Hospital, New Haven, CT"},{"name":"Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ketan R.","family":"Bulsara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Wang","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale\u2010New Haven Hospital, New Haven, CT"},{"name":"Department of Biostatistics, Harvard School of Public Health, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harlan M.","family":"Krumholz","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale\u2010New Haven Hospital, New Haven, CT"},{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT"},{"name":"Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT"},{"name":"Section of Health Policy and Administration, Yale School of Public Health, New Haven, CT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-4949.2006.00045.x"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.505776"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043033"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000089017.90037.7A"},{"key":"e_1_3_5_6_2","unstructured":"Approval order of Wingspan stent system. 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