CEA and CAS Comparative Effectiveness Evaluated in Medicare Population

 

April 20, 2012—An evaluation of the comparative effectiveness of carotid revascularization procedures stratified by Medicare age was published March 30 online ahead of print in the Journal of Vascular Surgery by Jeffrey Jim, MD, et al for the Society for Vascular Surgery (SVS) Outcomes Committee.

Using data from the SVS Vascular Registry, this study reported the influence of age on the comparative effectiveness of carotid endarterectomy (CEA) and carotid artery stenting (CAS). CAS resulted in inferior 30-day outcomes in symptomatic and asymptomatic patients aged ≥ 65 years compared with CEA; therefore, these findings do not support the widespread use of CAS in patients aged ≥ 65 years, the investigators concluded.

According to the investigators, the Vascular Registry collects provider-reported data on patients using a Web-based database. Patients were stratified by age and symptoms. The primary endpoint was the composite outcome of death, stroke, or myocardial infarction (MI) at 30 days.

As reported in the Journal of Vascular Surgery, as of December 7, 2010, there were 1,347 CEA and 861 CAS patients aged < 65 years and 4,169 CEA and 2,536 CAS patients aged ≥ 65 years. CAS patients in both age groups were more likely to have a disease etiology of radiation or restenosis, be symptomatic, and have more cardiac comorbidities.

In patients aged < 65 years, the primary endpoint (5.23% CAS vs 3.56% CEA; P = .065) did not reach statistical significance. Subgroup analyses showed that CAS had a higher combined death/stroke/MI rate (4.44% vs 2.1%; P < .031) in asymptomatic patients but there was no difference in the symptomatic (6% vs 5.47%; P = .79) group.

In patients aged ≥ 65 years, CEA had lower rates of death (0.91% vs 1.97%; P < .01), stroke (2.52% vs 4.89%; P < .01), and composite death/stroke/MI (4.27% vs 7.14%; P < .01). CEA in patients aged ≥ 65 years was associated with lower rates of the primary endpoint in symptomatic (5.27% vs 9.52%; P < .01) and asymptomatic (3.31% vs 5.27%; P < .01) subgroups. After risk adjustment, the investigators stated that CAS patients aged ≥ 65 years were more likely to reach the primary endpoint.

 

Contact Info

For advertising rates and opportunities, contact:
Craig McChesney
484-581-1816
cmcchesney@bmctoday.com

Stephen Hoerst
484-581-1817
shoerst@bmctoday.com

Charles Philip
484-581-1873
cphillip@bmctoday.com

About Endovascular Today

Endovascular Today is a publication dedicated to bringing you comprehensive coverage of all the latest technology, techniques, and developments in the endovascular field. Our Editorial Advisory Board is composed of the top endovascular specialists, including interventional cardiologists, interventional radiologists, vascular surgeons, neurologists, and vascular medicine practitioners, and our publication is read by an audience of more than 22,000 members of the endovascular community.

Website Design by Sides Media