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Carotid Stenosis: An Update on Early Outcomes Comparing Carotid Endarterectomy and Carotid Artery Stenting.
Abstract:
Objective: To compare the results of carotid endarterectomy (CEA) and carotid stenting (CAS) of patients with carotid stenosis in Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) from 2008 through 2010.
Methods: An analysis of approximately 8 million annual hospital admissions from 2008-2010 was obtained from the HCUP NIS database. Using ICD9 coding, we selected patients with the diagnosis of carotid stenosis and then created subsets of patients that underwent CEA versus CAS. The study focused on early outcomes including stroke, myocardial infarction (MI), and in-hospital mortality. SPSS version 19 was used for statistical analysis. Chi-squared tests and t-tests were used to confirm statistical significance if P< 0.05.
Results: Total number of patients admitted with the diagnosis of carotid stenosis from 2008-2010 was 276,043 representing an estimated 1.38 million admissions. Average age of CEA and CAS patients was 71.02 +/- 9.53 and 70.64 +/- 10.08 (P = 0.000). A total of 328,756 patients underwent CEA and 47,813 patients underwent CAS annually in the United States after weighted adjustment. Postoperative stroke rate for CEA versus CAS was 1.0% vs. 2.1% (OR 2.07, 95% CI 1.93 - 2.23, P=0.000). Postoperative stroke by individual year for CEA versus CAS was 1.0% vs. 2.1%, 1.1% vs. 2.3%, 1.0% vs. 2.1% for 2008, 2009, and 2010 respectively. In-hospital mortality for CEA vs. CAS was 0.4% vs. 1.0% (OR 2.58, 95% CI 2.32 - 2.87, P=0.000). Comparing mortality for CEA vs. CAS by year rates were 0.4% vs. 1.8%, 0.5% vs. 1.9%, 0.3% vs. 2.1% for 2008, 2009, and 2010 respectively. Postoperative MI for CEA vs. CAS was 1.4% vs. 1.9% (OR 1.33, 95% CI 1.24 - 1.44, P =0.000). Comparing postoperative MI for CEA vs. CAS by year rates were 1.5% vs. 1.7%, 1.6% vs. 2.1%, 1.2% vs. 2.0% for 2008, 2009, and 2010 respectively (Table 1).
Conclusion: Patients who underwent CEA for carotid stenosis had lower rates of postoperative stroke rate, MI, and in-hospital mortality compared to CAS.
Table 1. Comparison between CEA and CAS

	Postop stroke (%)			Postop MI (%)			Mortality (%)			LOS (Days)
	CEA	CAS	P	CEA	CAS	P	CEA	CAS	P	CEA	CAS
Gender
Male	1.0	2.1	0.000	1.5	1.9	0.000	0.4	1.1	0.000
Female	1.1	2.3	0.000	1.4	2.1	0.000	0.4	1.0	0.000
Age
>=80	1.1	3.0	0.000	1.5	1.9	0.000	0.7	1.2	0.000
<80	1.0	2.0	0.000	1.4	2.0	0.000	0.3	1.0	0.000
Symptoms
Symptomatic stenosis	2.6	6.0	0.000
Asymptomatic Stenosis	1.0	1.8	0.000
Year
2008	1.0	2.1	0.000	1.5	1.7	0.000	0.4	0.9	0.000	2.88	2.82
2009	1.1	2.3	0.000	1.6	2.1	0.000	0.5	1.0	0.000	2.81	2.88
2010	1.0	2.1	0.000	1.2	2.0	0.000	0.3	1.1	0.000	2.82	3.47