Bekelis K, et al. - The goal of this paper was to investigate the physician characteristics related to the exnovation (scaling back on use) and de-adoption (abandoning use) of carotid revascularization. The observation made was that surgeons with more experience and the lowest share in carotid revascularization practice reduced their use of the procedure the most. Such practice factors ought to be taken into account in the quality improvement efforts during the evolution of the evidence base, away from a specific treatment.