A Nationwide Comparison of Early Outcomes After Carotid Endarterectomy and Carotid Artery Stenting

Abstract

To compare short term outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in the Nationwide Inpatient Sample (NIS) database of the Healthcare Cost and Utilization Project (HCUP). An analysis of approximately 8 million hospital admissions per year from 2008 to 2012 was obtained from the HCUP NIS database. Using International Classification of Diseases, Ninth Revision, Clinical Modification codes, we selected patients with the diagnosis of carotid artery stenosis and then created a subset of patients that underwent either CEA or CAS. The study focused on early outcomes including stroke, perioperative myocardial infarction (MI), postoperative hematoma, and in-hospital mortality. Statistical analysis was done with IBM SPSS version 21. We used multivariate analysis to study the independent effect of type of procedure on the outcomes. After weighted adjustment, a total of 520,444 (22.4%) patients underwent CEA, and 78,337 (3.4%) patients underwent CAS. Average age of CEA and CAS patients was 71.0 + 9.5 years and 70.7 + 10.0 years, respectively (P = 0). The difference in percentage of octogenarians in both groups was not significant (20.1% vs 20.6%; P = .15). There were 58% males in the CEA group and 61% in the CAS group (P = 0). Postoperative stroke rate for CEA vs CAS was 1.0% vs 2.0% (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.91-2.45; P = 0). In the octogenarian subgroup, this difference increased to 1.0% vs 2.9% (OR, 2.91; 95% CI, 2.28-3.70; P = 0). MI for CEA vs CAS was 1.5% vs 1.9% (OR, 1.26; 95% CI, 1.18-1.43; P = 0). Postoperative hematoma for CEA vs CAS was 2.3% vs 2.1% (OR, 0.92; 95% CI, 0.82-1.03; P = .17), while in-hospital mortality for CEA vs CAS was 0.4% vs 1.0% (OR, 2.53; 95% CI, 2.10-3.04; P = 0). After adjusting for confounders, the differences in postoperative stroke, postoperative hematoma, and death between the two procedures were significant (all P < .05); however, contrary to the unadjusted result, the CAS showed significantly lower risk for MI (OR, 0.82; 95% CI, 0.73-0.97; P = .02). CEA has lower adjusted risk for postoperative stroke and death, while CAS has lower adjusted risk for MI and postoperative hematoma.