Abstract 15788: Percutaneous and Surgical Carotid Artery Revascularization in Patients With Moderate and Severe (Stage 3 and 4) Chronic Kidney Disease: Insights of the Healthcare Cost and Utilization Project’s National Inpatient Sample

Abstract

Background: Carotid artery stenting (CAS) has evolved into an alternative modality for the treatment of symptomatic and asymptomatic high-grade internal carotid artery stenosis, particularly in patients considered to be at a high surgical risk for carotid endarterectomy (CEA). Hypothesis: There is limited data on the outcomes of patients with moderate and severe chronic kidney disease (CKD) (GFR=15-59 mL/min/1.73m 2 ) (Stage 3 and 4) undergoing CEA or CAS. Methods: The Healthcare Cost and Utilization Project’s National Inpatient Sample was screened for hospital admissions of patients undergoing CAS and CEA from 2003-2012. Clinical characteristics and outcomes were identified in patients with stage 3 and 4 CKD. The primary outcome of interest was in-hospital major adverse cardiac and cerebrovascular events (MACCE) defined as the composite of in-hospital death, acute myocardial infarction (AMI) and acute cerebrovascular accident (CVA). Results: Our study population consisted of 3,608 patients that underwent CEA and 746 patients that underwent CAS. Patients undergoing CAS had significantly higher rates of coronary artery disease and peripheral vascular disease with similar rates of hypertension, diabetes and hyperlipidemia. There was a higher rate of in-hospital MACCE in patients undergoing CAS compared with patients that underwent CEA, mainly driven by a higher rate of in-hospital strokes (Fig. 1). AMI and mortality rates were similar in both groups. In a multivariable analysis, CAS (OR 1.52, 95% CI 1.25-1.84) was independently predictive of MACCE. Conclusions: In patients with moderate and severe CKD, CAS was associated with similar rates of in-hospital mortality and AMI rates but higher rates of stroke when compared with CEA.