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Carotid Angioplasty And Stenting And Carotid Endarterectomy In The Community - Analysis Of Outcomes Using Large Data Sets

Leila Mureebe¹, Natalia Egorova², Chihui Fang², Jeannine K. Giacovelli², James F. McKinsey¹, Peter L. Faries¹, Annetine Gelijns², Alan J. Moskowitz², K. Craig Kent.¹
1New York Presbyterian Hospital, New York, NY; ²International Center for Health Outcomes and Innovation Research; Columbia University College of Physicians and Surgeons, New York, NY.

OBJECTIVES: Medicare approved a distinct code identifying carotid angioplasty and stenting (CAS) in 2004. We sought to identify rates and risks for mortality and post-operative stroke in patients undergoing CAS and carotid endarterectomy (CEA) in a large population dataset.

METHODS: Hospital inpatient discharge data from California and New York for the year of 2005 were queried for patients who underwent either CEA or CAS. Comorbidities present on admission that were associated with or might impact the outcome of carotid intervention were surveyed. Odds ratios were calculated by multivariable logistic regression for predictors of mortality and post-operative stroke in all patients who underwent either CEA or CAS.

RESULTS: There were 14,785 CEA and 2,554 CAS performed during the period evaluated. Mortality for patients undergoing CAS was double that of CEA (CAS 1.41%, CEA 0.64%, p<0.0001), as was the risk of post-operative stroke (2.19% for CAS, 1.24% for CEA, p=0.002). To determine if outcomes for CAS differed from CEA in a high-risk population, we identified a subset of patients with significant comorbidities which included arrhythmia, acute myocardial infarction. renal failure, congestive heart failure and respiratory failure and anatomic abnormalities including neck irradiation or previous surgery. There were 7,996 patients in this cohort (46.1% of all patients undergoing CAS and CEA). Using multivariable logistic regression CAS was a predictor of both stroke (odds ratio: 1.820; 95% confidence interval: 1.262-2.625) and mortality (odds ratio: 2.604; 95% confidence interval: 1.583-4.284) in this high-risk group.

CONCLUSIONS: In all patients undergoing CAS or CEA, CEA is associated with a lower mortality and lower post-operative risk of stroke. Although patients who underwent CAS had significantly more comorbid conditions, CAS is an independent predictor of both postoperative stroke and death in both low risk and high risk populations. CEA remains a safe option for most patients who require carotid intervention.