Outcomes after carotid artery stenting and endarterectomy in the medicare population

Fen Wei Wang, Dennis Esterbrooks, Yong Fang Kuo, Aryan Mooss, Syed M. Mohiuddin, Barry F. Uretsky

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background and Purpose- Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for stroke prevention. The value of this therapy relative to CEA remains uncertain. Methods- In 10 958 Medicare patients aged 66 years or older between 2004 and 2006, we analyzed in-hospital, 1-year stroke, myocardial infarction, and death rate outcomes and the effects of potential confounding variables. Results- CAS patients (87% were asymptomatic) had a higher baseline risk profile, including having a higher percentage of coronary and peripheral arterial disease, heart failure, and renal failure. In-hospital stroke rate (1.9% CAS versus 1.4% CEA; P=0.14) and mortality (CAS 0.9% versus 0.6% CEA; P=0.20) were similar. By 1 year, CAS patients had similar stroke rates (5.3% CAS versus 4.1% CEA; P=0.12) but higher all-cause mortality rates (9.9% CAS versus 6.1% CEA; P<0.001). Using Cox multivariable models, there was a similar stroke risk (hazard ratio, 1.28; 95% CI, 0.90-1.79) but CAS patients had a significantly higher mortality (HR, 1.32; 95% CI, 1.02-1.71). Sensitivity analyses suggested that unmeasured confounders could be responsible for the mortality difference. In multivariable analysis, stroke risk was highest in the patients symptomatic at the time of revascularization. Conclusions- CAS patients had a similar stroke risk but an increased mortality rate at 1 year compared with CEA patients, possibly related to the higher baseline risk profile in the CAS patient group.

Original languageEnglish
Pages (from-to)2019-2025
Number of pages7
JournalStroke
Volume42
Issue number7
DOIs
StatePublished - Jul 2011

Fingerprint

Carotid Endarterectomy
Medicare
Carotid Arteries
Stroke
Population
Mortality
Confounding Factors (Epidemiology)
Peripheral Arterial Disease
Proportional Hazards Models
Renal Insufficiency
Heart Failure
Odds Ratio
Myocardial Infarction

Keywords

  • carotid artery stenting
  • carotid endarterectomy
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Wang, F. W., Esterbrooks, D., Kuo, Y. F., Mooss, A., Mohiuddin, S. M., & Uretsky, B. F. (2011). Outcomes after carotid artery stenting and endarterectomy in the medicare population. Stroke, 42(7), 2019-2025. https://doi.org/10.1161/STROKEAHA.110.608992

Outcomes after carotid artery stenting and endarterectomy in the medicare population. / Wang, Fen Wei; Esterbrooks, Dennis; Kuo, Yong Fang; Mooss, Aryan; Mohiuddin, Syed M.; Uretsky, Barry F.

In: Stroke, Vol. 42, No. 7, 07.2011, p. 2019-2025.

Research output: Contribution to journalArticle

Wang, FW, Esterbrooks, D, Kuo, YF, Mooss, A, Mohiuddin, SM & Uretsky, BF 2011, 'Outcomes after carotid artery stenting and endarterectomy in the medicare population', Stroke, vol. 42, no. 7, pp. 2019-2025. https://doi.org/10.1161/STROKEAHA.110.608992
Wang, Fen Wei ; Esterbrooks, Dennis ; Kuo, Yong Fang ; Mooss, Aryan ; Mohiuddin, Syed M. ; Uretsky, Barry F. / Outcomes after carotid artery stenting and endarterectomy in the medicare population. In: Stroke. 2011 ; Vol. 42, No. 7. pp. 2019-2025.
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abstract = "Background and Purpose- Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for stroke prevention. The value of this therapy relative to CEA remains uncertain. Methods- In 10 958 Medicare patients aged 66 years or older between 2004 and 2006, we analyzed in-hospital, 1-year stroke, myocardial infarction, and death rate outcomes and the effects of potential confounding variables. Results- CAS patients (87{\%} were asymptomatic) had a higher baseline risk profile, including having a higher percentage of coronary and peripheral arterial disease, heart failure, and renal failure. In-hospital stroke rate (1.9{\%} CAS versus 1.4{\%} CEA; P=0.14) and mortality (CAS 0.9{\%} versus 0.6{\%} CEA; P=0.20) were similar. By 1 year, CAS patients had similar stroke rates (5.3{\%} CAS versus 4.1{\%} CEA; P=0.12) but higher all-cause mortality rates (9.9{\%} CAS versus 6.1{\%} CEA; P<0.001). Using Cox multivariable models, there was a similar stroke risk (hazard ratio, 1.28; 95{\%} CI, 0.90-1.79) but CAS patients had a significantly higher mortality (HR, 1.32; 95{\%} CI, 1.02-1.71). Sensitivity analyses suggested that unmeasured confounders could be responsible for the mortality difference. In multivariable analysis, stroke risk was highest in the patients symptomatic at the time of revascularization. Conclusions- CAS patients had a similar stroke risk but an increased mortality rate at 1 year compared with CEA patients, possibly related to the higher baseline risk profile in the CAS patient group.",
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AU - Mohiuddin, Syed M.

AU - Uretsky, Barry F.

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N2 - Background and Purpose- Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for stroke prevention. The value of this therapy relative to CEA remains uncertain. Methods- In 10 958 Medicare patients aged 66 years or older between 2004 and 2006, we analyzed in-hospital, 1-year stroke, myocardial infarction, and death rate outcomes and the effects of potential confounding variables. Results- CAS patients (87% were asymptomatic) had a higher baseline risk profile, including having a higher percentage of coronary and peripheral arterial disease, heart failure, and renal failure. In-hospital stroke rate (1.9% CAS versus 1.4% CEA; P=0.14) and mortality (CAS 0.9% versus 0.6% CEA; P=0.20) were similar. By 1 year, CAS patients had similar stroke rates (5.3% CAS versus 4.1% CEA; P=0.12) but higher all-cause mortality rates (9.9% CAS versus 6.1% CEA; P<0.001). Using Cox multivariable models, there was a similar stroke risk (hazard ratio, 1.28; 95% CI, 0.90-1.79) but CAS patients had a significantly higher mortality (HR, 1.32; 95% CI, 1.02-1.71). Sensitivity analyses suggested that unmeasured confounders could be responsible for the mortality difference. In multivariable analysis, stroke risk was highest in the patients symptomatic at the time of revascularization. Conclusions- CAS patients had a similar stroke risk but an increased mortality rate at 1 year compared with CEA patients, possibly related to the higher baseline risk profile in the CAS patient group.

AB - Background and Purpose- Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for stroke prevention. The value of this therapy relative to CEA remains uncertain. Methods- In 10 958 Medicare patients aged 66 years or older between 2004 and 2006, we analyzed in-hospital, 1-year stroke, myocardial infarction, and death rate outcomes and the effects of potential confounding variables. Results- CAS patients (87% were asymptomatic) had a higher baseline risk profile, including having a higher percentage of coronary and peripheral arterial disease, heart failure, and renal failure. In-hospital stroke rate (1.9% CAS versus 1.4% CEA; P=0.14) and mortality (CAS 0.9% versus 0.6% CEA; P=0.20) were similar. By 1 year, CAS patients had similar stroke rates (5.3% CAS versus 4.1% CEA; P=0.12) but higher all-cause mortality rates (9.9% CAS versus 6.1% CEA; P<0.001). Using Cox multivariable models, there was a similar stroke risk (hazard ratio, 1.28; 95% CI, 0.90-1.79) but CAS patients had a significantly higher mortality (HR, 1.32; 95% CI, 1.02-1.71). Sensitivity analyses suggested that unmeasured confounders could be responsible for the mortality difference. In multivariable analysis, stroke risk was highest in the patients symptomatic at the time of revascularization. Conclusions- CAS patients had a similar stroke risk but an increased mortality rate at 1 year compared with CEA patients, possibly related to the higher baseline risk profile in the CAS patient group.

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