Quality of Life Compared for CAS Versus CEA

May 21, 2010—A study comparing health-related quality of life in patients undergoing carotid artery stenting (CAS) versus surgical endarterectomy (CEA) from the SAPPHIRE (Stenting and Angioplasty With Protection in Patients at High Risk for Endarterectomy) trial was published by Joshua M. Stolker, MD, et al in the Journal of the American College of Cardiology: Cardiovascular Interventions (2010;3:515–523).

The investigators evaluated health-related quality of life in the SAPPHIRE trial, which randomized 334 high-risk patients with carotid stenosis to CAS versus CEA. Health status assessments were obtained at baseline, 2 weeks, and 1, 6, and 12 months after revascularization. Generic measures included the Short-Form-36 (0–100 scale), general health rating, and EuroQol-5D. In addition, the investigators used six disease-specific modified Likert scales to assess difficulty with walking, eating/swallowing, driving, headaches, neck pain, and leg pain.

According to the investigators, in patients treated according to protocol (n = 159 for CAS; n = 151 for CEA), CAS patients had better scores at 2 weeks for the Short-Form-36 role physical scale (mean difference, 9; 95% confidence interval, 0.9–17.1; P = .031), but these differences had resolved by 1-month follow-up. For the disease-specific scales, CAS patients reported less difficulty eating/swallowing at 2 weeks, less difficulty driving at 2 weeks, and less neck pain at 2 weeks; each of these differences between groups was no longer present at 1 month. No other scores differed between groups at any time point.

From these findings, the investigators concluded that among patients at high surgical risk, CAS was associated with less health status impairment during the first 2 weeks of recovery when compared with CEA. These differences had resolved by 1 month after the procedure, and no other differences between revascularization strategies in health-related quality of life were found.