Subject: Anthem Policy Mechanical Embolectomy for Treatment of Acute Stroke
Dear Dr. Whitney,
On behalf of the American Association of Neurological Surgeons (AANS), the American Society of
Neuroradiology, the Congress of Neurological Surgeons (CNS), the Society of Neurointerventional
Surgery, and the Society of Vascular and Interventional Neurologists, we would like to thank WellPoint
and Anthem for the opportunity to comment on the Anthem medical policy SURG.00098 (Effective Date:
4/11/2012) on the subject of “Mechanical Embolectomy for Treatment of Acute Stroke.” We appreciate
the efforts of your team in developing a review of the published literature reporting on the use of
mechanical embolectomy in the treatment of acute stroke, but disagree that such intervention is
investigational and not medically necessary.
We believe that for acute ischemic stroke, mechanical embolectomy is a medically necessary option in
appropriate in patients with medical indications as determined by their treating physician. Our
assessment of the literature would indicate that mechanical embolectomy is an appropriate option in
patients:
- Presenting outside the 3-4.5 hour window for intravenous tissue plasminogen activator (IV tPA).
- Patients in whom IV tPA was not effective at recanalizing the vessel.
- Patients who have calcified clots or calcified deposits.
- Patients who have large vessel occlusion of their internal carotid artery (ICA) or basilar artery
(BA)
…
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