Decision aids for patients with carotid stenosis

J Vasc Surg. 2024 Mar;79(3):704-707. doi: 10.1016/j.jvs.2023.10.050. Epub 2023 Nov 3.

Abstract

Background: Shared decision-making tools have been underused by clinicians in real-world practice. Changes to the National Coverage Determination by Medicare for carotid stenting greatly expand the coverage for patients, but simultaneously require a shared decision-making interaction that involves the use of a validated tool. Accordingly, our objective was to evaluate the currently available decision aids for carotid stenosis.

Methods: We conducted a review of the literature for published work on decision aids for the treatment of carotid disease.

Results: Four publications met inclusion criteria. We found the format of the decision aid impacted patient comprehension and decision making, although patient characteristics also played a role in the therapeutic decisions made. Notably, none of the available decision aids included the widely adopted transcarotid artery revascularization as an option.

Conclusions: Further work is needed in the development of a widespread validated decision aid instrument for patients with carotid stenosis.

Keywords: Carotid artery stenosis; Carotid disease; Decision aid; Patient preferences; Shared decision-making.

Publication types

  • Review

MeSH terms

  • Carotid Stenosis* / diagnostic imaging
  • Carotid Stenosis* / surgery
  • Decision Support Techniques
  • Humans
  • Medicare
  • Stents
  • Treatment Outcome
  • United States
  • Vascular Surgical Procedures