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Home > Vascular Annual Meeting > vogel_carotid_stenting

Carotid Stenting and Endarterectomy: Outcomes in the United States

Todd R. Vogel, Viktor Y. Dombrovskiy, Paul 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), but the majority of CAS studies are derived from high volume or single-institution centers and are often not generalizable to the practice in the nation. We hypothesized that complications occur more frequently after CAS than reported in the literature.

METHODS: To evaluate single-setting discharge outcomes after CAS and CEA in patients ≥60 years in the United States, we examined the 2005 Nationwide Inpatient Sample. To identify cases with CAS and CEA as well as postoperative complications, we used specific ICD-9-CM diagnostic and procedures codes.

RESULTS: In 118,251 carotid interventions (107,077 CEA and 11,174 CAS), the incidence of postoperative stroke was found to be 10.3% for CAS and 5.5% for CEA (p<.0001). There was no significant difference in the incidence of cardiac complications between the two groups (3.29% vs. 3.26%, p=NS). Pulmonary complications were significantly higher after CEA when compared to CAS (1.75% vs. 0.39%, p<.0001). LOS was not significantly different between the two procedures (3.0 days for CAS vs. 3.2 days for CEA, p=.0539), but the cost was greater for CAS ($15,666) when compared to CEA ($10,951; p<.0001). In an age, gender and complication adjusted model no differences were found in the mortality between groups. The most important predictors of the postoperative mortality were postoperative stroke (odds ratio [OR]=13.2, 95%CI= 9.4-18.4), cardiac complications (OR=7.7; 95%CI=5.1-11.5) and pulmonary complications (OR=6.6, 95%CI=4.2-10.5).

CONCLUSIONS: These data show a significant increase in the risk of stroke after CAS when compared to CEA. Additionally, no differences in the rates of postoperative cardiac complications were found between the two procedures. LOS was not different between the two procedures, but cost was significantly greater for CAS. The most significant predictor of death after CAS was a postoperative stroke. With the dramatic differences in outcomes and cost for CAS, further research is needed to assist practitioners is in optimizing treatment of carotid disease in the nation.

AUTHOR DISCLOSURES: T.R. Vogel, None; V.Y. Dombrovskiy, None; P. Haser, None; A.M.