Does current practice in the United States of carotid artery stent placement benefit asymptomatic octogenarians

K. C. Young, B. S. Jahromi

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: CAS or CEA for asymptomatic carotid stenosis is the focus of recently completed and ongoing randomized clinical trials. These techniques are widely utilized outside the setting of such trials. Therefore, our goal was to analyze the in-hospital stroke or death rates after CAS or CEA for asymptomatic stenosis that reflect current nationwide practice. MATERIALS AND METHODS: Using sample-weighted ANOVA, we analyzed records from the 2006 and 2007 NIS, which are nationally representative cohorts for asymptomatic CAS or CEA. The primary outcome measure was a composite end point of in-hospital stroke, cardiac complications, or death. In-hospital stroke or death was a secondary outcome measure. RESULTS: For ≥80 years of age, the in-hospital stroke, cardiac complications, or death rate after CAS was 4.9%, while the complication rate after CEA was 3.8%. The stroke or death rate after CAS was 2.7% for ≥80 years of age and was 1.5% after CEA for the same age group. Multivariate analysis showed that age (OR, 1.12; 95% CI, 0.97-1.3; P < .07) or procedure (OR, 1.12; 95% CI, 0.99 -1.27; P < .14) was not associated with the composite end point of in-hospital stroke, cardiac complications, or death. In contrast, CAS (OR, 1.28; 95% CI, 1.03-1.58) and female sex (OR, 1.23; 95% CI, 1.04 -1.45) were independently associated with in-hospital stroke or death following asymptomatic carotid revascularization. Hospital charges and hospital costs were lower for CEA than CAS (2007 costs: $7779 versus $12,104). CONCLUSIONS: CAS is independently associated with increased in-hospital stroke or death (excluding cardiac complications from the composite outcome). In those ≥80 years of age, CAS as currently performed may not improve the natural history of asymptomatic carotid stenosis, because in-hospital stroke or death rates following CAS approached 3% in this group.

Original languageEnglish (US)
Pages (from-to)170-173
Number of pages4
JournalAmerican Journal of Neuroradiology
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2011

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Carotid Arteries
Stents
Stroke
Mortality
Carotid Stenosis
Outcome Assessment (Health Care)
Hospital Charges
Hospital Costs
Analysis of Variance
Pathologic Constriction
Multivariate Analysis
Randomized Controlled Trials
Age Groups
Costs and Cost Analysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

@article{70736211afae4e29b9f72592b3286ee1,
title = "Does current practice in the United States of carotid artery stent placement benefit asymptomatic octogenarians",
abstract = "BACKGROUND AND PURPOSE: CAS or CEA for asymptomatic carotid stenosis is the focus of recently completed and ongoing randomized clinical trials. These techniques are widely utilized outside the setting of such trials. Therefore, our goal was to analyze the in-hospital stroke or death rates after CAS or CEA for asymptomatic stenosis that reflect current nationwide practice. MATERIALS AND METHODS: Using sample-weighted ANOVA, we analyzed records from the 2006 and 2007 NIS, which are nationally representative cohorts for asymptomatic CAS or CEA. The primary outcome measure was a composite end point of in-hospital stroke, cardiac complications, or death. In-hospital stroke or death was a secondary outcome measure. RESULTS: For ≥80 years of age, the in-hospital stroke, cardiac complications, or death rate after CAS was 4.9{\%}, while the complication rate after CEA was 3.8{\%}. The stroke or death rate after CAS was 2.7{\%} for ≥80 years of age and was 1.5{\%} after CEA for the same age group. Multivariate analysis showed that age (OR, 1.12; 95{\%} CI, 0.97-1.3; P < .07) or procedure (OR, 1.12; 95{\%} CI, 0.99 -1.27; P < .14) was not associated with the composite end point of in-hospital stroke, cardiac complications, or death. In contrast, CAS (OR, 1.28; 95{\%} CI, 1.03-1.58) and female sex (OR, 1.23; 95{\%} CI, 1.04 -1.45) were independently associated with in-hospital stroke or death following asymptomatic carotid revascularization. Hospital charges and hospital costs were lower for CEA than CAS (2007 costs: $7779 versus $12,104). CONCLUSIONS: CAS is independently associated with increased in-hospital stroke or death (excluding cardiac complications from the composite outcome). In those ≥80 years of age, CAS as currently performed may not improve the natural history of asymptomatic carotid stenosis, because in-hospital stroke or death rates following CAS approached 3{\%} in this group.",
author = "Young, {K. C.} and Jahromi, {B. S.}",
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Does current practice in the United States of carotid artery stent placement benefit asymptomatic octogenarians. / Young, K. C.; Jahromi, B. S.

In: American Journal of Neuroradiology, Vol. 32, No. 1, 01.01.2011, p. 170-173.

Research output: Contribution to journalReview article

TY - JOUR

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AU - Young, K. C.

AU - Jahromi, B. S.

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N2 - BACKGROUND AND PURPOSE: CAS or CEA for asymptomatic carotid stenosis is the focus of recently completed and ongoing randomized clinical trials. These techniques are widely utilized outside the setting of such trials. Therefore, our goal was to analyze the in-hospital stroke or death rates after CAS or CEA for asymptomatic stenosis that reflect current nationwide practice. MATERIALS AND METHODS: Using sample-weighted ANOVA, we analyzed records from the 2006 and 2007 NIS, which are nationally representative cohorts for asymptomatic CAS or CEA. The primary outcome measure was a composite end point of in-hospital stroke, cardiac complications, or death. In-hospital stroke or death was a secondary outcome measure. RESULTS: For ≥80 years of age, the in-hospital stroke, cardiac complications, or death rate after CAS was 4.9%, while the complication rate after CEA was 3.8%. The stroke or death rate after CAS was 2.7% for ≥80 years of age and was 1.5% after CEA for the same age group. Multivariate analysis showed that age (OR, 1.12; 95% CI, 0.97-1.3; P < .07) or procedure (OR, 1.12; 95% CI, 0.99 -1.27; P < .14) was not associated with the composite end point of in-hospital stroke, cardiac complications, or death. In contrast, CAS (OR, 1.28; 95% CI, 1.03-1.58) and female sex (OR, 1.23; 95% CI, 1.04 -1.45) were independently associated with in-hospital stroke or death following asymptomatic carotid revascularization. Hospital charges and hospital costs were lower for CEA than CAS (2007 costs: $7779 versus $12,104). CONCLUSIONS: CAS is independently associated with increased in-hospital stroke or death (excluding cardiac complications from the composite outcome). In those ≥80 years of age, CAS as currently performed may not improve the natural history of asymptomatic carotid stenosis, because in-hospital stroke or death rates following CAS approached 3% in this group.

AB - BACKGROUND AND PURPOSE: CAS or CEA for asymptomatic carotid stenosis is the focus of recently completed and ongoing randomized clinical trials. These techniques are widely utilized outside the setting of such trials. Therefore, our goal was to analyze the in-hospital stroke or death rates after CAS or CEA for asymptomatic stenosis that reflect current nationwide practice. MATERIALS AND METHODS: Using sample-weighted ANOVA, we analyzed records from the 2006 and 2007 NIS, which are nationally representative cohorts for asymptomatic CAS or CEA. The primary outcome measure was a composite end point of in-hospital stroke, cardiac complications, or death. In-hospital stroke or death was a secondary outcome measure. RESULTS: For ≥80 years of age, the in-hospital stroke, cardiac complications, or death rate after CAS was 4.9%, while the complication rate after CEA was 3.8%. The stroke or death rate after CAS was 2.7% for ≥80 years of age and was 1.5% after CEA for the same age group. Multivariate analysis showed that age (OR, 1.12; 95% CI, 0.97-1.3; P < .07) or procedure (OR, 1.12; 95% CI, 0.99 -1.27; P < .14) was not associated with the composite end point of in-hospital stroke, cardiac complications, or death. In contrast, CAS (OR, 1.28; 95% CI, 1.03-1.58) and female sex (OR, 1.23; 95% CI, 1.04 -1.45) were independently associated with in-hospital stroke or death following asymptomatic carotid revascularization. Hospital charges and hospital costs were lower for CEA than CAS (2007 costs: $7779 versus $12,104). CONCLUSIONS: CAS is independently associated with increased in-hospital stroke or death (excluding cardiac complications from the composite outcome). In those ≥80 years of age, CAS as currently performed may not improve the natural history of asymptomatic carotid stenosis, because in-hospital stroke or death rates following CAS approached 3% in this group.

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