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MORTALITY RATE OF CAROTID ARTERY STENTING AND CAROTID ENDARTERECTOMY - THE NATIONAL RESULTS

OBJECTIVES: To examine real-world outcomes and associated risk factors of carotid artery stenting (CAS) at the national level, outside of clinical trials and registries. We compared mortality rates between CAS and carotid endarterectomy (CEA) from 2001 to 2004.
METHODS: Patient discharges for revascularization of carotid artery stenosis from 2001 to 2004 were identified using the Nationwide Inpatient Sample (NIS) database. The 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 as identifiers in the NIS. The primary outcome measure was in-hospital mortality with univariate and multivariate analysis adjusting for age, race, sex, comorbidities, admission diagnosis and type, length of stay, hospital type and charges.
RESULTS: There were 590,559 carotid revascularization procedures between 2001 and 2004, comprising of 563,583 CEA (95%) and 26,976 CAS (5%). There was a reduction in the number of CEA performed in 2004, which differed from its previous upward trend, while the number of CAS performed continued to increase annually. Mean patient age was 71 years for both groups, with a predominance of white (90%) male (57%) patients admitted electively (80%). 67% of CAS was performed at urban teaching hospitals. Inpatient mortality for CAS was significantly higher at 1.6% compared to 0.7% for CEA [P<.005]. Logistic regression analysis revealed CAS was an independent predictor of increased in-hospital mortality as compared to CEA (Relative Risk. 2.2; 95% C.I.: 1.1 to 4.6). Additional independent significant risk factors for death were coronary artery disease and congestive heart failure. Although the average length of stay was similar for both CEA and CAS at 3 days, average hospital charges were higher for CAS ($32,326) as compared to CEA ($24,086) [P < 0.001].
CONCLUSIONS:CAS has a significantly higher mortality rate compared to CEA in clinical practice, based on a large representative national sample over a five year time period. CAS performed continued to increase despite its higher mortality rate and cost, compared to surgical revascularization