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Home > Press Center > Carotid Endartrectomy Has Lower Mortality Rates than Carotid Stenting

Contact:
Emily Kalata
Assistant Director, Communications
312.334.2309

EMBARGOED FOR RELEASE, JUNE 7, 2007, 8:35 a.m.
Study to be presented at Vascular Annual Meeting June 7-10

Carotid endarterectomy (CEA), outside of controlled trials, continues to be associated with a lower in-hospital mortality rates and postoperative stroke than carotid stenting (CAS) for treatment of carotid artery stenosis, regardless of neurological symptoms. The results of the study were presented at the 61st Annual Meeting of the Society for Vascular Surgery. 

A study data from the Nationwide Inpatient Sample was compiled from records of approximately 217,468 patient discharges from U.S. hospitals following revascularization for carotid artery stenosis. Primary outcomes were in-hospital mortality and morbidities, such as postoperative stroke and myocardial infarction (MI). Ninety-seven percent of the procedures were in patients without an initial diagnosis of stroke.

Stroke was 4.0 times more common among CAS patients who also had 7.5 times higher in-hospital mortality than CEA patients. These results were higher even though CEA patients were older, had higher rate of hypertension, chronic lung disease, congestive heart failure and renal failure, according to researchers; CAS patients had a higher rate of renal failure. Postoperative cardiac events and other co-morbidities were equally distributed among the two treatment groups. 

“In the past CEA has been proven to be the standard of care after multiple trials showing its benefit in patients who had carotid stenosis,” said Mohammad H. Eslami, MD, from the division of vascular surgery at the University of Massachusetts Medical Center in Worcester. 

“Male patients who have more than 60 percent angiographically-proven carotid stenosis would benefit from CEA regardless their neurological symptoms,” added Dr. Eslami. “The main benefit of this therapy is to prevent stroke. There have been similar CEA benefits in females, but with slightly higher degree of stenosis. The use of CEA decreases patients’ rate of stroke compared to those patients treated with medication.”

“Currently, CEA is recommended by most vascular surgeons when patients have moderate stenosis symptoms (“mini stroke” (transient ischemic attacks) or stroke), or in patients who have more than 80 percent stenosis by ultrasound but have no symptoms provided they are fit to undergo surgery,” said Dr. Eslami. Most vascular surgeons use carotid duplex performed in an accredited vascular lab to guide patients’ therapy or follow-up. 

Researchers noted that despite excellent results with CEA at most high volume institutions, it often is performed under general anesthesia and in a progressively older population, alternatives have been sought and endovascular therapies have brought CAS to the forefront as a possible alternative to open surgical procedure. 

They added that one concern with endovascular procedure is the inability to protect the cerebral circulation from microemboli that may reach the brain circulation during the endovascular interventions. Recently distal protective devices have been invented and used to avoid distal embolization. A CAS procedure with such a device has been approved by the Centers for Medicare and Medicaid Services (CMS) as an alternative therapy to CEA for patients with symptomatic high grade stenosis who are not fit for surgery or in recurrence of high grade stenosis after CEA. Some prospective, controlled randomized studies claim that when used in this manner, CAS is “not an inferior” to CEA in terms of death, stroke or MI.  

“However, as an endovascular surgeon who performs CAS, I think our study clearly shows that we have to be very selective in offering CAS since CEA results are so much better,” said Dr. Eslami. “This study raises great concern about the use of CAS in asymptomatic patients. The CMS should consider this and other studies very carefully before allowing reimbursement for CAS for asymptomatic but “high risk” patients. I believe that CAS should only be offered in very morbid patients with active neurological symptoms.”

      
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Contact Jill Goodwin, 312-334-2308 or communications@vascularsociety.org, to attend the 61st Vascular Annual Meeting in Baltimore, Md. June 7-10.