Comparison of carotid endarterectomy and stenting in real world practice using a regional quality improvement registry.

Journal of Vascular Surgery
Brian W NolanVascular Study Group of New England

Abstract

Carotid artery stenting (CAS) vs endarterectomy (CEA) remains controversial and has been the topic of recent randomized controlled trials. The purpose of this study was to compare the practice and outcomes of CAS and CEA in a real world setting. This is a retrospective analysis of 7649 CEA and 430 CAS performed at 17 centers from 2003 to 2010 within the Vascular Study Group of New England (VSGNE). The primary outcome measures were (1) any in-hospital stroke or death and (2) any stroke, death, or myocardial infarction (MI). Patients undergoing CEA in conjunction with cardiac surgery were excluded. Multivariate logistic regression was performed to identify predictors of stroke or death in patients undergoing CAS. CEA was performed in 17 centers by 111 surgeons, while CAS was performed in 6 centers by 30 surgeons and 8 interventionalists. Patient characteristics varied by procedure. Patients undergoing CAS had a higher prevalence of coronary artery disease, congestive heart failure, diabetes, and prior ipsilateral CEA. Embolic protection was used in 97% of CAS. Shunts were used in 48% and patches in 86% of CEA. The overall in-hospital stroke or death rate was higher among patients undergoing CAS (2.3% vs 1.1%; P = .03). Overall st...Continue Reading

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Citations

Sep 9, 2015·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·K I ParaskevasA R Naylor
Feb 14, 2013·Journal of Vascular Surgery·Jessica P SimonsUNKNOWN Vascular Study Group of New England
Feb 8, 2013·Journal of Vascular Surgery·Margriet FokkemaMarc L Schermerhorn
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Jul 19, 2018·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Ashwat S DhillonParveen Garg
Apr 27, 2020·Annals of Vascular Surgery·Hallie J QuirozRishi Rattan
Mar 10, 2021·Stroke and Vascular Neurology·James Francis BurkeRodney A Hayward
Apr 24, 2019·Journal of Vascular Surgery·Besma NejimMahmoud B Malas

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