Study Looks at Geographic Variations in Carotid Revascularization During Early Years of CAS

July 27, 2010—In the Archives of Internal Medicine, Manesh R. Patel, MD, et al published findings from a study funded by the US Department of Health and Human Services' Agency for Healthcare Research and Quality that looked at changes in carotid revascularization among Medicare beneficiaries from 2003 through 2006 (2010;170:1218–1225). The study examined geographic variation in and predictors of carotid endarterectomy (CEA) and carotid artery stenting (CAS). Little is known about patterns in the use of carotid revascularization since the 2004 Medicare national coverage decision supporting CAS, stated the investigators.

The investigators concluded that significant geographic variation existed for use of CEA and CAS, and that previous CEA and coronary disease were associated with greater odds of CAS.

The study involved an analysis of claims from the Centers for Medicare & Medicaid Services from January 1, 2003 through December 31, 2006. Patients were 65 years or older and had undergone CEA or CAS. The main outcome measures were annual age-adjusted rates of CEA and CAS, factors associated with the use of carotid revascularization, and mortality rate at 30 days and 1 year.

As detailed in the Archives of Internal Medicine, the rate of CEA decreased from 3.2 per 1,000 person-years in 2003 to 2.6 per 1,000 person-years in 2006. After adjustment for demographic and clinical characteristics, there was significant geographic variation in the odds of carotid revascularization, with the East North Central region having the greatest odds of CEA (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.55–1.65) and CAS (OR, 1.61; 95% CI, 1.46–1.78) compared with New England. Previous CEA (OR, 3.06; 95% CI, 2.65–3.53) and coronary artery disease (OR, 2.12; 95% CI 2.03–2.21) were strong predictors of CAS. In 2005, mortality rates were 1.2% at 30 days and 6.8% at 1 year for CEA and 2.3% at 30 days and 10.3% at 1 year for CAS, the investigators reported.