Study Compares Trends and Outcomes of CAS Versus CEA from 2001 to 2010

September 9, 2014—In a comparison of trends and outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA) in the United States performed from 2001 to 2010, Luke K. Kim, MD, et al concluded that CAS was associated with worse in-hospital outcomes, which was partly attributable to selection and ascertainment bias. They also found that asymptomatic patients undergoing CAS versus CEA had similar adjusted rates of major adverse events.

However, the investigators noted that CAS outcomes improved significantly during the course of the decade, which was likely attributable to improvements in patient selection, operator skills, and technological advancements. The study is available online ahead of print in Circulation: Cardiovascular Interventions.

The investigators advised that the background of the study is that given the controversy regarding whether CAS or CEA may be superior for stroke prevention, it is uncertain how recent clinical evidence, guidelines, and reimbursement policies have influenced the volume and outcomes after these procedures.

As summarized in Circulation: Cardiovascular Interventions, the investigators conducted a serial, cross-sectional study with time trends of patients undergoing CAS (n = 124,265) and CEA (n = 1,260,647) between 2001 and 2010 from the Nationwide Inpatient Sample database. The frequency of CEA declined and the use of CAS slowly increased during the 10-year period.

After multivariate propensity score–matched analysis, CAS was associated with an increased risk of death (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.40–2.04), stroke (OR, 1.43; 95% CI, 1.23–1.66), and major adverse events including death, stroke, and myocardial infarction (OR, 1.25; 95% CI, 1.13–1.39).

In asymptomatic patients, there was no significant difference in major adverse events (OR, 1.08; 95% CI, 0.92–1.20; P = .16 [P < .001 for interaction between procedure type and symptom status]) between CAS and CEA.

Importantly, there was a significant improvement in CAS outcomes during the course of 10 years (reduction in death [OR, 0.51; 95% CI, 0.49–0.67; P for trend = .03] and major adverse events [OR, 0.75; 95% CI, 0.66–0.84; P for trend = .05] comparing years 2010 versus 2001), reported the investigators in Circulation: Cardiovascular Interventions.