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Carotid Artery Stenting Outcomes are Significantly Worse Compared to Endarterectomy at One Year
Sapan S. Desai, MD, PhD, MBA1, Todd Roberts, MBA2, Jim Wilkerson2, James Pan, MD1, Douglas Hood, MD1, Kim J. Hodgson, MD1.
1Southern Illinois University, Springfield, IL, USA, 2Memorial Medical Center, Springfield, IL, USA.

OBJECTIVES:
Several studies have evaluated the outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS). The purpose of this study is to compare the outcomes of patients who underwent CEA and CAS at 30 days and 1 year.
METHODS:
Asymptomatic patients who underwent elective CEA and CAS were identified using state-level inpatient (SID) and outpatient (SASD) databases provided by the AHRQ from 2010-2013. Complications, including stroke, MI, bleeding, and death were identified. Patients were tracked for one year and total cost of care determined, adjusted for 2015 USD using the Consumer Price Index. A risk-adjusted analysis using the Charlson score was also completed.
RESULTS:
We identified 2,439 patients who underwent CEA, of which 6.1% developed a complication (1.5% stroke, 1.6% MI, 2.7% bleeding) and 0.2% died at 30 days. At one year following CEA, 7.8% had developed a complication (1.7% stroke, 2.5% MI, and 3.1% bleeding) and 0.5% had died. Over the same time period, 140 patients underwent CAS, of which 7.9% developed a complication (1.9% stroke, 2.3% MI, 3.4% bleeding) and 0.1% had died at 30 days. At one year following CAS, 10.3% had developed a complication (2.6% stroke, 3.3% MI, and 3.6% bleeding) and 1.9% had died. Total costs following CEA were \,690 at 30 days and \,613 at one year. Total costs following CAS were \,711 at 30 days and \,698 at one year. CAS had a higher rate of complications (P<0.05 for each complication), death (P<0.01), and cost (P<0.001) at one year, and for cost only at 30 days (P<0.05). Outcomes at one year for CAS compared to CEA were significantly worse after risk adjustment for stroke (OR 4.2, P<0.001) and mortality (OR 2.1, P0.05) and bleeding (OR 1.04, P>0.05).
CONCLUSIONS:
Differences between CEA and CAS are significant only for cost at 30 days. However, one year outcomes related to stroke, MI, bleeding, mortality, and cost of care are significantly worse for patients who undergo CAS. A risk-adjusted analysis shows no significant difference in MI or bleeding rates between CAS and CEA at one year, but there is a significantly greater risk of stroke and death following CAS. Patients who are candidates for either CEA or CAS may therefore benefit from endarterectomy.


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