Intracranial Hemorrhage Found to Be More Common After CAS Than After CEA

October 10, 2011—In Stroke, Robert J. McDonald, MD, et al have published findings from a study that sought to determine the prevalence, type, and risk factors associated with intracranial hemorrhage (ICH) among patients who have undergone carotid endarterectomy (CEA) or angioplasty and carotid artery stenting (CAS) within the National Inpatient Sample (NIS) (2011;42:2782–2787).

As detailed in Stroke, the investigators retrieved postoperative cases of ICH after CEA (International Classification of Disease 9th edition [ICD-9]: 38.12) or CAS (ICD-9: 00.63) from the 2001 to 2008 NIS. Clinical presentation (asymptomatic vs symptomatic), discharge status, in-hospital mortality, demographics, and hospital characteristics were extracted from the NIS data. Charlson indices of comorbidity were determined based on ICD-9 and clinical classification software codes. Multivariate regression was used to determine the impact of revascularization procedure type and symptom status on adverse outcomes, including ICH, in-hospital mortality, and unfavorable discharge status.

The investigators stated that 215,012 CEA and 13,884 CAS procedures were performed among 57,663,486 NIS hospital admissions. Symptomatic presentations represented the minority of CEA (n = 10,049; 5%) and CAS cases (n = 1,251; 10%). ICH occurred significantly more frequently after CAS than after CEA in both symptomatic (4.4% vs 0.8%; P < .0001) and asymptomatic presentations (0.5% vs 0.06%; P < .0001). Multivariate regression suggested that symptomatic presentations (vs asymptomatic) and CAS procedures (vs CEA) were both independently predictive of six- to seven-fold increases in the frequency of postoperative ICH. ICH was independently predictive of a 30-fold increased risk of mortality before discharge, reported the investigators in Stroke.

The investigators concluded that CAS procedures are associated with elevated adverse outcomes, including ICH, in-hospital death, and unfavorable discharges, especially among symptomatic presentations.