Regional variation in patient selection and treatment for carotid artery disease in the Vascular Quality Initiative
Abstract Objective Previous studies involving large administrative data sets have revealed regional variation in the demographics of patients selected for carotid endarterectomy (CEA) and carotid artery stenting (CAS) but lacked clinical granularity. This study aimed to evaluate regional variation i...
Gespeichert in:
| Veröffentlicht in: | Journal of vascular surgery 2017-07, Vol.66 (1), p.112-121 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 121 |
|---|---|
| container_issue | 1 |
| container_start_page | 112 |
| container_title | Journal of vascular surgery |
| container_volume | 66 |
| creator | Shean, Katie E., MD McCallum, John C., MD Soden, Peter A., MD Deery, Sarah E., MD Schneider, Joseph R., MD, PhD Nolan, Brian W., MD Rockman, Caron B., MD Schermerhorn, Marc L., MD, FACS |
| description | Abstract Objective Previous studies involving large administrative data sets have revealed regional variation in the demographics of patients selected for carotid endarterectomy (CEA) and carotid artery stenting (CAS) but lacked clinical granularity. This study aimed to evaluate regional variation in patient selection and operative technique for carotid artery revascularization using a detailed clinical registry. Methods All patients who underwent CEA or CAS from 2009 to 2015 were identified in the Vascular Quality Initiative (VQI). Deidentified regional groups were used to evaluate variation in patient selection, operative technique, and perioperative management. χ2 analysis was used to identify significant variation across regions. Results A total of 57,555 carotid artery revascularization procedures were identified. Of these, 49,179 patients underwent CEA (asymptomatic: median, 56%; range, 46%-69%; P < .01) and 8376 patients underwent CAS (asymptomatic: median, 36%; range, 29%-51%; P < .01). There was significant regional variation in the proportion of asymptomatic patients being treated for carotid stenosis |
| doi_str_mv | 10.1016/j.jvs.2017.01.023 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5483386</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S074152141730191X</els_id><sourcerecordid>1883180131</sourcerecordid><originalsourceid>FETCH-LOGICAL-c506t-3c1971466d770aeb8068c724d36202cc4a21647252ec5b949bc83bfebfa70113</originalsourceid><addsrcrecordid>eNp9ksFu1DAQhiMEotvCA3BBPnJJ8NhJ7AipEqqAVqqEgApxsxxn0nrxxovtRNq3x2FLBRw4eWTP_8-MvymKF0AroNC-3lbbJVaMgqgoVJTxR8UGaCfKVtLucbGhooayYVCfFKcxbikFaKR4WpwwyZtOQLcp4me8tX7Sjiw6WJ1yTOxE9jnCKZGIDs2vSz0NJAXUabfejz4Qo4NPdiA6JAwHMtiIOuKqTndIvupoZqcD-TRrZ9OBXE02rQUWfFY8GbWL-Pz-PCtu3r-7ubgsrz9-uLp4e12ahrap5AZyj3XbDkJQjb2krTSC1QNvGWXG1JpBWwvWMDRN39VdbyTvR-xHLfKk_Kw4P9ru536Hg8l9B-3UPtidDgfltVV_v0z2Tt36RTW15Fy22eDVvUHwP2aMSe1sNOicntDPUYGUHCQFvtaCY6oJPsaA40MZoGplpbYqs1IrK0VBZVZZ8_LP_h4Uv-HkhDfHBMyftFgMKppMxeBgQ6aiBm__a3_-j9o4O1mj3Xc8YNz6OWTseQoVmaLqy7os666A4BQ6-MZ_AuZMvJM</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1883180131</pqid></control><display><type>article</type><title>Regional variation in patient selection and treatment for carotid artery disease in the Vascular Quality Initiative</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Shean, Katie E., MD ; McCallum, John C., MD ; Soden, Peter A., MD ; Deery, Sarah E., MD ; Schneider, Joseph R., MD, PhD ; Nolan, Brian W., MD ; Rockman, Caron B., MD ; Schermerhorn, Marc L., MD, FACS</creator><creatorcontrib>Shean, Katie E., MD ; McCallum, John C., MD ; Soden, Peter A., MD ; Deery, Sarah E., MD ; Schneider, Joseph R., MD, PhD ; Nolan, Brian W., MD ; Rockman, Caron B., MD ; Schermerhorn, Marc L., MD, FACS ; Society for Vascular Surgery Vascular Quality Initiative</creatorcontrib><description><![CDATA[Abstract Objective Previous studies involving large administrative data sets have revealed regional variation in the demographics of patients selected for carotid endarterectomy (CEA) and carotid artery stenting (CAS) but lacked clinical granularity. This study aimed to evaluate regional variation in patient selection and operative technique for carotid artery revascularization using a detailed clinical registry. Methods All patients who underwent CEA or CAS from 2009 to 2015 were identified in the Vascular Quality Initiative (VQI). Deidentified regional groups were used to evaluate variation in patient selection, operative technique, and perioperative management. χ2 analysis was used to identify significant variation across regions. Results A total of 57,555 carotid artery revascularization procedures were identified. Of these, 49,179 patients underwent CEA (asymptomatic: median, 56%; range, 46%-69%; P < .01) and 8376 patients underwent CAS (asymptomatic: median, 36%; range, 29%-51%; P < .01). There was significant regional variation in the proportion of asymptomatic patients being treated for carotid stenosis <70% in CEA (3%-9%; P < .01) vs CAS (3%-22%; P < .01). There was also significant variation in the rates of intervention for asymptomatic patients older than 80 years (CEA, 12%-27% [ P < .01]; CAS, 8%-26% [ P < .01]). Preoperative computed tomography angiography or magnetic resonance angiography in the CAS cohort also varied widely (31%-83%; P < .01), as did preoperative medical management with combined aspirin and statin (CEA, 53%-77% [ P < .01]; CAS, 62%-80% [ P < .01]). In the CEA group, the use of shunt (36%-83%; P < .01), protamine (32%-89%; P < .01), and patch (87%-99%; P < .01) varied widely. Similarly, there was regional variation in frequency of CAS done without a protection device (1%-8%; P < .01). Conclusions Despite clinical benchmarks aimed at guiding management of carotid disease, wide variation in clinical practice exists, including the proportion of asymptomatic patients being treated by CAS and preoperative medical management. Additional intraoperative variables, including the use of a patch and protamine during CEA and use of a protection device during CAS, displayed similar variation in spite of clear guidelines. Quality improvement projects could be directed toward improved adherence to benchmarks in these areas.]]></description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2017.01.023</identifier><identifier>PMID: 28359719</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Angioplasty - adverse effects ; Angioplasty - instrumentation ; Angioplasty - trends ; Benchmarking - trends ; Carotid Stenosis - diagnostic imaging ; Carotid Stenosis - surgery ; Carotid Stenosis - therapy ; Chi-Square Distribution ; Computed Tomography Angiography - trends ; Endarterectomy, Carotid - adverse effects ; Endarterectomy, Carotid - trends ; Female ; Guideline Adherence - trends ; Healthcare Disparities - trends ; Humans ; Magnetic Resonance Angiography - trends ; Male ; Patient Selection ; Practice Guidelines as Topic ; Practice Patterns, Physicians' - trends ; Predictive Value of Tests ; Process Assessment (Health Care) - trends ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Surgery ; Time Factors ; Treatment Outcome ; United States</subject><ispartof>Journal of vascular surgery, 2017-07, Vol.66 (1), p.112-121</ispartof><rights>Society for Vascular Surgery</rights><rights>2017 Society for Vascular Surgery</rights><rights>Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c506t-3c1971466d770aeb8068c724d36202cc4a21647252ec5b949bc83bfebfa70113</citedby><cites>FETCH-LOGICAL-c506t-3c1971466d770aeb8068c724d36202cc4a21647252ec5b949bc83bfebfa70113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S074152141730191X$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28359719$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shean, Katie E., MD</creatorcontrib><creatorcontrib>McCallum, John C., MD</creatorcontrib><creatorcontrib>Soden, Peter A., MD</creatorcontrib><creatorcontrib>Deery, Sarah E., MD</creatorcontrib><creatorcontrib>Schneider, Joseph R., MD, PhD</creatorcontrib><creatorcontrib>Nolan, Brian W., MD</creatorcontrib><creatorcontrib>Rockman, Caron B., MD</creatorcontrib><creatorcontrib>Schermerhorn, Marc L., MD, FACS</creatorcontrib><creatorcontrib>Society for Vascular Surgery Vascular Quality Initiative</creatorcontrib><title>Regional variation in patient selection and treatment for carotid artery disease in the Vascular Quality Initiative</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description><![CDATA[Abstract Objective Previous studies involving large administrative data sets have revealed regional variation in the demographics of patients selected for carotid endarterectomy (CEA) and carotid artery stenting (CAS) but lacked clinical granularity. This study aimed to evaluate regional variation in patient selection and operative technique for carotid artery revascularization using a detailed clinical registry. Methods All patients who underwent CEA or CAS from 2009 to 2015 were identified in the Vascular Quality Initiative (VQI). Deidentified regional groups were used to evaluate variation in patient selection, operative technique, and perioperative management. χ2 analysis was used to identify significant variation across regions. Results A total of 57,555 carotid artery revascularization procedures were identified. Of these, 49,179 patients underwent CEA (asymptomatic: median, 56%; range, 46%-69%; P < .01) and 8376 patients underwent CAS (asymptomatic: median, 36%; range, 29%-51%; P < .01). There was significant regional variation in the proportion of asymptomatic patients being treated for carotid stenosis <70% in CEA (3%-9%; P < .01) vs CAS (3%-22%; P < .01). There was also significant variation in the rates of intervention for asymptomatic patients older than 80 years (CEA, 12%-27% [ P < .01]; CAS, 8%-26% [ P < .01]). Preoperative computed tomography angiography or magnetic resonance angiography in the CAS cohort also varied widely (31%-83%; P < .01), as did preoperative medical management with combined aspirin and statin (CEA, 53%-77% [ P < .01]; CAS, 62%-80% [ P < .01]). In the CEA group, the use of shunt (36%-83%; P < .01), protamine (32%-89%; P < .01), and patch (87%-99%; P < .01) varied widely. Similarly, there was regional variation in frequency of CAS done without a protection device (1%-8%; P < .01). Conclusions Despite clinical benchmarks aimed at guiding management of carotid disease, wide variation in clinical practice exists, including the proportion of asymptomatic patients being treated by CAS and preoperative medical management. Additional intraoperative variables, including the use of a patch and protamine during CEA and use of a protection device during CAS, displayed similar variation in spite of clear guidelines. Quality improvement projects could be directed toward improved adherence to benchmarks in these areas.]]></description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angioplasty - adverse effects</subject><subject>Angioplasty - instrumentation</subject><subject>Angioplasty - trends</subject><subject>Benchmarking - trends</subject><subject>Carotid Stenosis - diagnostic imaging</subject><subject>Carotid Stenosis - surgery</subject><subject>Carotid Stenosis - therapy</subject><subject>Chi-Square Distribution</subject><subject>Computed Tomography Angiography - trends</subject><subject>Endarterectomy, Carotid - adverse effects</subject><subject>Endarterectomy, Carotid - trends</subject><subject>Female</subject><subject>Guideline Adherence - trends</subject><subject>Healthcare Disparities - trends</subject><subject>Humans</subject><subject>Magnetic Resonance Angiography - trends</subject><subject>Male</subject><subject>Patient Selection</subject><subject>Practice Guidelines as Topic</subject><subject>Practice Patterns, Physicians' - trends</subject><subject>Predictive Value of Tests</subject><subject>Process Assessment (Health Care) - trends</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ksFu1DAQhiMEotvCA3BBPnJJ8NhJ7AipEqqAVqqEgApxsxxn0nrxxovtRNq3x2FLBRw4eWTP_8-MvymKF0AroNC-3lbbJVaMgqgoVJTxR8UGaCfKVtLucbGhooayYVCfFKcxbikFaKR4WpwwyZtOQLcp4me8tX7Sjiw6WJ1yTOxE9jnCKZGIDs2vSz0NJAXUabfejz4Qo4NPdiA6JAwHMtiIOuKqTndIvupoZqcD-TRrZ9OBXE02rQUWfFY8GbWL-Pz-PCtu3r-7ubgsrz9-uLp4e12ahrap5AZyj3XbDkJQjb2krTSC1QNvGWXG1JpBWwvWMDRN39VdbyTvR-xHLfKk_Kw4P9ru536Hg8l9B-3UPtidDgfltVV_v0z2Tt36RTW15Fy22eDVvUHwP2aMSe1sNOicntDPUYGUHCQFvtaCY6oJPsaA40MZoGplpbYqs1IrK0VBZVZZ8_LP_h4Uv-HkhDfHBMyftFgMKppMxeBgQ6aiBm__a3_-j9o4O1mj3Xc8YNz6OWTseQoVmaLqy7os666A4BQ6-MZ_AuZMvJM</recordid><startdate>20170701</startdate><enddate>20170701</enddate><creator>Shean, Katie E., MD</creator><creator>McCallum, John C., MD</creator><creator>Soden, Peter A., MD</creator><creator>Deery, Sarah E., MD</creator><creator>Schneider, Joseph R., MD, PhD</creator><creator>Nolan, Brian W., MD</creator><creator>Rockman, Caron B., MD</creator><creator>Schermerhorn, Marc L., MD, FACS</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170701</creationdate><title>Regional variation in patient selection and treatment for carotid artery disease in the Vascular Quality Initiative</title><author>Shean, Katie E., MD ; McCallum, John C., MD ; Soden, Peter A., MD ; Deery, Sarah E., MD ; Schneider, Joseph R., MD, PhD ; Nolan, Brian W., MD ; Rockman, Caron B., MD ; Schermerhorn, Marc L., MD, FACS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c506t-3c1971466d770aeb8068c724d36202cc4a21647252ec5b949bc83bfebfa70113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angioplasty - adverse effects</topic><topic>Angioplasty - instrumentation</topic><topic>Angioplasty - trends</topic><topic>Benchmarking - trends</topic><topic>Carotid Stenosis - diagnostic imaging</topic><topic>Carotid Stenosis - surgery</topic><topic>Carotid Stenosis - therapy</topic><topic>Chi-Square Distribution</topic><topic>Computed Tomography Angiography - trends</topic><topic>Endarterectomy, Carotid - adverse effects</topic><topic>Endarterectomy, Carotid - trends</topic><topic>Female</topic><topic>Guideline Adherence - trends</topic><topic>Healthcare Disparities - trends</topic><topic>Humans</topic><topic>Magnetic Resonance Angiography - trends</topic><topic>Male</topic><topic>Patient Selection</topic><topic>Practice Guidelines as Topic</topic><topic>Practice Patterns, Physicians' - trends</topic><topic>Predictive Value of Tests</topic><topic>Process Assessment (Health Care) - trends</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shean, Katie E., MD</creatorcontrib><creatorcontrib>McCallum, John C., MD</creatorcontrib><creatorcontrib>Soden, Peter A., MD</creatorcontrib><creatorcontrib>Deery, Sarah E., MD</creatorcontrib><creatorcontrib>Schneider, Joseph R., MD, PhD</creatorcontrib><creatorcontrib>Nolan, Brian W., MD</creatorcontrib><creatorcontrib>Rockman, Caron B., MD</creatorcontrib><creatorcontrib>Schermerhorn, Marc L., MD, FACS</creatorcontrib><creatorcontrib>Society for Vascular Surgery Vascular Quality Initiative</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shean, Katie E., MD</au><au>McCallum, John C., MD</au><au>Soden, Peter A., MD</au><au>Deery, Sarah E., MD</au><au>Schneider, Joseph R., MD, PhD</au><au>Nolan, Brian W., MD</au><au>Rockman, Caron B., MD</au><au>Schermerhorn, Marc L., MD, FACS</au><aucorp>Society for Vascular Surgery Vascular Quality Initiative</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Regional variation in patient selection and treatment for carotid artery disease in the Vascular Quality Initiative</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2017-07-01</date><risdate>2017</risdate><volume>66</volume><issue>1</issue><spage>112</spage><epage>121</epage><pages>112-121</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract><![CDATA[Abstract Objective Previous studies involving large administrative data sets have revealed regional variation in the demographics of patients selected for carotid endarterectomy (CEA) and carotid artery stenting (CAS) but lacked clinical granularity. This study aimed to evaluate regional variation in patient selection and operative technique for carotid artery revascularization using a detailed clinical registry. Methods All patients who underwent CEA or CAS from 2009 to 2015 were identified in the Vascular Quality Initiative (VQI). Deidentified regional groups were used to evaluate variation in patient selection, operative technique, and perioperative management. χ2 analysis was used to identify significant variation across regions. Results A total of 57,555 carotid artery revascularization procedures were identified. Of these, 49,179 patients underwent CEA (asymptomatic: median, 56%; range, 46%-69%; P < .01) and 8376 patients underwent CAS (asymptomatic: median, 36%; range, 29%-51%; P < .01). There was significant regional variation in the proportion of asymptomatic patients being treated for carotid stenosis <70% in CEA (3%-9%; P < .01) vs CAS (3%-22%; P < .01). There was also significant variation in the rates of intervention for asymptomatic patients older than 80 years (CEA, 12%-27% [ P < .01]; CAS, 8%-26% [ P < .01]). Preoperative computed tomography angiography or magnetic resonance angiography in the CAS cohort also varied widely (31%-83%; P < .01), as did preoperative medical management with combined aspirin and statin (CEA, 53%-77% [ P < .01]; CAS, 62%-80% [ P < .01]). In the CEA group, the use of shunt (36%-83%; P < .01), protamine (32%-89%; P < .01), and patch (87%-99%; P < .01) varied widely. Similarly, there was regional variation in frequency of CAS done without a protection device (1%-8%; P < .01). Conclusions Despite clinical benchmarks aimed at guiding management of carotid disease, wide variation in clinical practice exists, including the proportion of asymptomatic patients being treated by CAS and preoperative medical management. Additional intraoperative variables, including the use of a patch and protamine during CEA and use of a protection device during CAS, displayed similar variation in spite of clear guidelines. Quality improvement projects could be directed toward improved adherence to benchmarks in these areas.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28359719</pmid><doi>10.1016/j.jvs.2017.01.023</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0741-5214 |
| ispartof | Journal of vascular surgery, 2017-07, Vol.66 (1), p.112-121 |
| issn | 0741-5214 1097-6809 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5483386 |
| source | MEDLINE; Elsevier ScienceDirect Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Aged, 80 and over Angioplasty - adverse effects Angioplasty - instrumentation Angioplasty - trends Benchmarking - trends Carotid Stenosis - diagnostic imaging Carotid Stenosis - surgery Carotid Stenosis - therapy Chi-Square Distribution Computed Tomography Angiography - trends Endarterectomy, Carotid - adverse effects Endarterectomy, Carotid - trends Female Guideline Adherence - trends Healthcare Disparities - trends Humans Magnetic Resonance Angiography - trends Male Patient Selection Practice Guidelines as Topic Practice Patterns, Physicians' - trends Predictive Value of Tests Process Assessment (Health Care) - trends Registries Retrospective Studies Risk Assessment Risk Factors Surgery Time Factors Treatment Outcome United States |
| title | Regional variation in patient selection and treatment for carotid artery disease in the Vascular Quality Initiative |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T15%3A28%3A46IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Regional%20variation%20in%20patient%20selection%20and%20treatment%20for%20carotid%20artery%20disease%20in%20the%20Vascular%20Quality%20Initiative&rft.jtitle=Journal%20of%20vascular%20surgery&rft.au=Shean,%20Katie%20E.,%20MD&rft.aucorp=Society%20for%20Vascular%20Surgery%20Vascular%20Quality%20Initiative&rft.date=2017-07-01&rft.volume=66&rft.issue=1&rft.spage=112&rft.epage=121&rft.pages=112-121&rft.issn=0741-5214&rft.eissn=1097-6809&rft_id=info:doi/10.1016/j.jvs.2017.01.023&rft_dat=%3Cproquest_pubme%3E1883180131%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1883180131&rft_id=info:pmid/28359719&rft_els_id=1_s2_0_S074152141730191X&rfr_iscdi=true |