Study Compares National Trends for Early Years of CAS Versus CEA

December 6, 2010—Findings from a study comparing trends in utilization, mortality, and stroke after carotid artery angioplasty and stenting (CAS) and carotid endarterectomy (CEA) in the United States from 2005 to 2007 were published by Mohammad H. Eslami, MD, et al online ahead of print in the Journal of Vascular Surgery.

In the study, the Nationwide Inpatient Sample (NIS) was queried for patient discharges with International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes for CAS and CEA. The primary outcomes were in-hospital mortality, stroke, hospital charges, and discharge disposition. Subgroup analyses were performed to evaluate these outcomes by neurologic presentation using χ2 and multivariable logistic regression.

According to the investigators, of the 404,256 discharges for carotid revascularization, CAS utilization was 66% higher in 2006 than in 2005 (9.3% vs 14%; P = .0004). Crude mortality, stroke, and median charges remained higher for CAS than for CEA; discharge to home was more common after CEA. Results improved from 2005 to 2007. By logistic regression of the total cohort from 2005 to 2006, CAS was independently predictive of mortality (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.08–2; P < .0001). Independent predictors of stroke included CAS (OR, 1.43; 95% CI, 1.18–1.73; P < .0001) and symptomatic disease (OR, 2.4; 95% CI, 2.06–2.93; P < .0001).

Among subgroups based on neurological presentation, regression showed that CAS significantly increased the odds of stroke in asymptomatic patients (OR, 1.6; 95% CI, 1.2–2; P = .0003). Among symptomatic patients, CAS increased the odds of in-hospital death (OR, 3.0; 95% CI, 1.7–5.1; P < .0001) and trended toward significance for stroke (OR, 1.7; 95% CI, 1–2.8; P = .0569).

The investigators concluded that CAS utilization has increased from the years 2005 to 2007 with some improvements in the outcome; however, resource utilization remains significantly higher for CAS than CEA.