Abstract
Background:
Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS) are both viable treatment options for carotid artery stenosis. Factors including surgical risk, age, and symptomatic status are often used to help guide management decisions.
Methods:
We conducted a retrospective observational study using the National Surgical Quality Improvement Program (NSQIP) database to compare 30-day post-procedure outcomes including mortality, stroke, and myocardial infarction in patient with carotid stenosis undergoing CEA (n=54,640) versus CAS (n=488) from 2005 to 2012. Procedure type was identified by CPT codes.
Findings:
Patients undergoing CEA were more likely to be older and have symptomatic stenosis, and less likely to be white, have CHF, and have COPD. There was no significant difference between CEA and CAS in 30-day mortality (0.9% vs. 1.2%, p=0.33), stroke (1.6% vs. 1.6% p=0.93), myocardial infarction (0.9% vs. 1.6%, p=0.08), or combined outcome (3.0% vs. 4.9%, p=0.09). The interaction between symptomatic status and procedure type was not significant (p=0.29), indicating the association of symptomatic status with 30-day mortality was similar in cases receiving CEA and CAS.
Conclusion:
Early outcomes after CEA and CAS for carotid artery stenosis appear to be similar in a ‘real-world’ sample and comparable to clinical trials. Patients undergoing CAS were more likely to be younger and surgically higher risk based on baseline characteristics likely reflecting clinical practice case selection.