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Outcomes after carotid artery stenting and endarterectomy in the Medicare population

Fen Wei Wang1, Dennis Esterbrooks, Yong-Fang Kuo

  • 1Cardiac Center, Department of Medicine, Creighton University, 3006 Webster Street, Omaha, NE 68131, USA. FenWeiWang@Creighton.edu

Stroke
|May 28, 2011
PubMed

Insights

Carotid artery stenting (CAS) showed similar stroke risk but higher mortality compared to carotid endarterectomy (CEA). Higher baseline risk in CAS patients may explain the increased mortality. Further research is needed.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Interventional Cardiology

Background:

  • Carotid artery stenting (CAS) is an established alternative to carotid endarterectomy (CEA) for preventing strokes.
  • The comparative effectiveness and safety of CAS versus CEA remain subjects of ongoing clinical investigation.

Purpose of the Study:

  • To compare the outcomes of CAS and CEA in a large Medicare population.
  • To evaluate stroke, myocardial infarction, and mortality rates associated with both procedures.

Main Methods:

  • Analysis of 10,958 Medicare patients aged 66+ from 2004-2006.
  • Comparison of in-hospital and 1-year outcomes, including stroke and mortality rates.
  • Utilized Cox multivariable models and sensitivity analyses to adjust for confounding variables.

Main Results:

  • CAS patients exhibited a higher baseline risk profile, with more comorbidities like coronary and peripheral arterial disease, heart failure, and renal failure.
  • In-hospital and 1-year stroke rates were similar between CAS and CEA groups (P=0.14 and P=0.12, respectively).
  • One-year all-cause mortality was significantly higher in the CAS group compared to the CEA group (9.9% vs 6.1%, P<0.001).

Conclusions:

  • CAS is associated with similar stroke risk but increased 1-year mortality compared to CEA.
  • The higher mortality observed in CAS patients may be attributed to their greater baseline risk profile.
  • Symptomatic status at the time of revascularization was identified as a significant factor for stroke risk.
Abstract

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