CAS use increased, outcomes improved during recent 10-year period

Usage of carotid artery stenting increased and outcomes associated with that intervention improved between 2001 and 2010, recent findings concluded.

The researchers suggested that it is unknown how recent clinical evidence, guidelines and reimbursement structures have impacted usage rates and outcomes in carotid artery stenting (CAS) or carotid endarterectomy (CEA) for prevention of stroke.

The current serial, cross-sectional study included 124,265 patients who underwent CAS and 1,260,647 patients who underwent CEA.

Patients were accrued from the Nationwide Inpatient Sample database.

Usage of CAS slowly increased while usage of CEA decreased over the 10-year duration of the study. Results of a multivariable, propensity score matched analysis indicated that CAS yielded an increased mortality risk (OR=1.69; 95% CI, 1.40-2.04), along with an increased risk for stroke (OR=1.43; 95% CI, 1.23-1.66) and major adverse events, including death, stroke and MI (OR=1.25; 95% CI, 1.13-1.39).

No significant difference was reported between the two interventions in terms of major adverse events among asymptomatic individuals (OR=1.08; 95% CI, 0.92-1.20; P=.16; P<.001 for interaction between procedure type and symptom status), according to the results.

CAS was associated with a significant improvement in mortality (OR=0.51; 95% CI, 0.49-0.67) and major adverse events (OR=0.75; 95% CI, 0.66-0.84) from 2001 to 2010.

“In US hospitals between 2001 and 2010, CAS was associated with worse in-hospital outcomes, partly attributable to selection and ascertainment bias,” the researchers concluded. “CAS outcomes improved significantly during the course of the decade likely attributable to improvements in patient selection, operator skills and technological advancements.”

Source: www.healio.com