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Home > Vascular Annual Meeting > pvss12_carotid_vogel

PVSS1. Carotid Stenting and Endarterectomy in the United States: Age and Outcomes

Todd R. Vogel, Viktor Y. Dombrovskiy, Joel C. Cantor, Paul B. Haser, Alan M. Graham.
UMDNJ-Robert Wood Johnson Medical School, New Brunswick, N.J. 

OBJECTIVES: With the evolution of endovascular techniques, carotid artery stenting (CAS) has been compared to carotid endarterectomy (CEA). However, the majority of aging studies in this area are derived from high-volume or single institutions and their results may not be extrapolated to all hospitals offering such treatment.

METHODS: We evaluated the 2005 Nationwide Inpatient Sample for hospitalizations with a procedure of CAS or CEA within two days after admission at age 60 years and above. Procedures were analyzed with respect to patient demographics and associated complications.

RESULTS: 80,498 carotid interventions (73,929 CEA and 6,569 CAS) were identified. The overall incidence of stroke was 4.16% after CAS and 2.66% after CEA (p<.0001). CAS was more often utilized in octogenarians than in younger patients (7.92% in 60-69 vs. 8.55% in 80+ years; p<.0002). Increased age was not associated with a greater stroke rates after CAS or CEA (p=NS). Cardiac and pulmonary complications after CEA were greater in octogenarians (3.0% vs.1.9% and 2.2% vs. 1.3% respectively; p<.0001); this was not seen after CAS (p=NS). When adjusted by age, gender, complications and Elixhauser comorbidities, patients after CAS were1.6 times as likely to have a stroke (CI=1.37-1.78) when compared to CEA. Significant predictors of postoperative hospital mortality were stroke (OR=29.0; 95% CI=21.54-39.08), cardiac complications (OR=6.4; 95% CI=4.44-9.09), and pulmonary complications (OR=3.5; 95% CI=2.31-5.19). With increasing age, overall mortality steadily increased after CAS (from 0.23% to 0.67%; p=.0409) but remained stable after CEA.

CONCLUSIONS: Elderly patients did not have a higher risk of stroke after CAS when compared to younger patients. Stroke was the strongest predictor of hospital mortality. The increased utilization of CAS in the aged, which had significantly higher stroke rates in all age groups studied, may account for the greater hospital mortality seen after CAS with aging. Further research is needed to improve outcomes of carotid disease in the elderly.