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Home > Vascular Annual Meeting > wang_increasing_carotid

Increasing Number of Carotid Stenting Procedures Performed with Decreasing Mortality – The National Experience

John C. Wang1, John Blebea1, Paul van Bemmelen1, Frank Schmieder1, Michael Salvatore1, John Gaughan.2
1Temple University Hospital, Philadelphia, Pa.;2Temple University School of Medicine, Philadelphia, Pa.

OBJECTIVES: Carotid artery stenting (CAS) continues to be a procedure of major continuing interest and controversy. We examined the national trends in its utilization and associated mortality and compared them to carotid endarterectomy (CEA) during the time period from 2001 to 2005.

METHODS: Discharge data following revascularization of carotid artery stenosis were identified using the latest Nationwide Inpatient Sample (NIS) database. Procedure codes for CEA (38.12) and CAS (39.50, 39.90, 00.61 and 00.63) were cross-referenced with ICD9-CM diagnostic codes for carotid artery stenosis. Primary outcome measures were in-hospital mortality and post-procedural CVA with univariate and multivariate analysis adjusting for age, race, sex, comorbidities, admission diagnosis and type, length of stay, hospital type and charges.

RESULTS: During the five-year time period between 2001 and 2005, there were 582,565 CEA (94%) and 39,829 CAS (6%) performed. Although the number of CEA has stayed essentially unchanged during this five year time period, there has been a continuing increase in CAS, more than doubling from 5473 in 2001 to 12,919 cases in 2005. Although overall CAS had twice the post-procedural stroke rate as compared to CEA (1.94% vs. 1.1%; p<0.005), and a significantly higher mortality rate of 1.3% vs. 0.6% (p<0.005) there has been a significant and progressive decrease in national CAS mortality, from 1.8% in 2001 to 1.0% in 2005 (p<0.05). Logistic regression analysis revealed CAS as an independent predictor of increased in-hospital mortality compared to CEA (relative risk 2.3; p<0.05). Another significant independent risk factor for death was pre-procedural stroke, with a 50-fold increase in risk.

CONCLUSIONS: Although CAS continues to have both a higher mortality and stroke rate as compared to CEA, the number of CAS procedures nationally continues to increase significantly each year. The mortality rate with CAS, however, is decreasing.

 

AUTHOR DISCLOSURES: J.C. Wang, None; J. Blebea, None; P. van Bemmelen, None; F. Schmieder, None; M. Salvatore, None; J. Gaughan, None.