Stenosis Measurement in Carotid Imaging Studies (NQF 0507)

EMeasure Name Stenosis Measurement in Carotid Imaging Studies EMeasure Id 1ED1FB60-AA88-480C-A93E-7E74BECCE0D8
Version number 1 Set Id 392AE3DA-1F5A-4CE0-AFD2-5344B8208C6E
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by National Quality Forum
Description Percentage of final reports for carotid imaging studies (neck MR angiography [MRA], neck CT angiography [CTA], neck duplex ultrasound, carotid angiogram) performed that include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement.
Copyright
© 2010 American Medical Association and/or National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Since the clinical decision-making is based on randomized trial evidence and degree of stenosis is an important element of the decision for carotid intervention, characterization of the degree of stenosis needs to be standardized. Requiring that stenosis calculation be based on a denominator of distal internal carotid diameter or, in the case of duplex ultrasound, velocity measurements that have been correlated to angiographic stenosis calculation based on distal internal carotid diameter, makes the measure applicable to both imaging and duplex studies.
Clinical Recommendation Statement
For patients with symptomatic atherosclerotic carotid stenosis >70%, as defined using the NASCET criteria, the value of carotid endarterectomy (CEA) has been clearly established from the results of 3 major prospective randomized trials: the NASCET, the European Carotid Surgery Trial (ECST), and the Veterans Affairs Cooperative Study Program. Among symptomatic patients with TIAs or minor strokes and high-grade carotid stenosis, each trial showed impressive relative and absolute risk reductions for those randomized to surgery. For patients with carotid stenosis <50%, these trials showed that there was no significant benefit of surgery. (ASA)

It is important to consider that the degree of carotid stenosis in ECST was measured differently than that in NASCET. The degree of carotid stenosis is significantly higher if calculated by the NASCET rather than the ECST method. In summary, it appears that patients with a recent TIA or nondisabling stroke with ipsilateral carotid stenosis benefit from surgery if the stenosis is >50% as measured by the NASCET method; however, this benefit appears to be less pronounced in women. Recently symptomatic patients with >70% stenosis as measured by the NASCET method can expect a far greater benefit from carotid endarterectomy. (AHA)
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Sacco RL, Adams R, Albers G, Alberts MJ, et al. Guidelines for Preventions of Stroke in Patients with Ischemic Stroke or Transient Ischemic Attack: A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke. Stroke 2006;37:577-617.
Reference
Albers GW, Hart RG, Lutsep HL, Newell DW, Sacco RL. Supplement to the Guidelines for the Management of Transient Ischemic Attacks: A statement from the ad hoc committee on guidelines for the management of transient ischemic attacks, Stroke Council, American Heart Association (AHA). Stroke 1999; 30; 2501-2511.
Definition
"Direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement" includes direct angiographic stenosis calculation based on the distal lumen as the denominator for stenosis measurement OR an equivalent validated method referenced to the above method (eg, for duplex ultrasound studies, velocity parameters that correlate with anatomic measurements that use the distal internal carotid lumen as the denominator for stenosis measurement)
Guidance
Eligible cases for this measure included every final report for carotid imaging studies performed during the measurement period.  Each final report for carotid imaging studies counts separately in the denominator.

Table of Contents


Population criteria

Data criteria (QDS Data Elements)

Summary Calculation

Calculation is generic to all measures:



Measure set CLINICAL QUALITY MEASURE SET 2011-2012