Study Compares Early Outcomes After CAS and CEA for Asymptomatic Carotid Stenosis

January 7, 2015—In Stroke, Jay Chol Choi, MD, et al published findings from a study of early outcomes after carotid artery stenting (CAS) with carotid endarterectomy (CEA) for asymptomatic carotid stenosis (2015;46:120–125). The investigators concluded that for asymptomatic carotid stenosis, CAS is associated with a substantially higher risk of postoperative stroke or in-hospital death than CEA even after adjustment for baseline differences in hospital and patient characteristics.

According to the investigators, the study’s background outlined that, despite the absence of definitive data from randomized clinical trials on the comparative effectiveness of CAS versus CEA for asymptomatic carotid stenosis, the use of CAS has been expanding and seems to be displacing the use of CEA in some parts of the United States.

As summarized in Stroke, the investigators used comprehensive hospital discharge data from January 2010 to December 2012, to identify patients who had CEA or CAS for asymptomatic carotid stenosis at all academic medical centers that participate in the University HealthSystem Consortium. In-hospital death and postoperative stroke after CAS and after CEA were compared using multivariable logistic regression, propensity score matching, and a grouped-treatment approach using multilevel mixed-effects models to adjust for baseline characteristics of patients selected for these procedures.

The study identified 17,716 patients with asymptomatic carotid stenosis treated with CEA and 3,962 treated with CAS at 186 University HealthSystem Consortium hospitals.

The investigators found that postoperative stroke or in-hospital death was more frequent after CAS than CEA (4% vs 1.5%; P < .001), and patients with CAS were more likely to have these adverse outcomes even after adjusting for baseline characteristics using multivariable analysis (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1–3.1; P < .001) and propensity score matching (OR, 2.5; 95% CI, 1.9–3.4; P < .001). In a multilevel mixed-effects model, hospitals that performed a higher proportion of all carotid revascularization cases using CAS had significantly higher rates of adverse outcomes (OR, 3.7; 95% CI, 1.8–7.6; P < .001) after adjusting for patient-level variables, reported the investigators in Stroke.