In Hospital Outcome of CEA And CAS in the German National Carotid Registry 2014-2015

Abstract

Introduction - The German National Quality Assurance Registry includes the datasets of all procedures (CEA and CAS) performed in German hospitals. The in-hospital outcome is reported by a questionnaire and finally evaluated and monitored by a federal institution (IQTIG) with the assistance of a clinical advisory board. It is the aim of this presentation to report the outcome of CEA vs. CAS as well as of simultaneous procedures combined with cardiac surgery or intracranial endovascular procedures. Methods - Data were collected at discharge on a electronic basis and primarily transferred to local state agencies (n=11) for plausibility check and monitoring. The data sets from 11 agencies were then anonymously compiled and evaluated by a federal institute (IQTIG). The quality of the registry is checked on a yearly basis by random sample analysis of individual charts. Data collection is linked to reimbursement of the procedure. The reports from 2014 and 2015 include the data sets from n= 64.868patients. 12.156 CAS (18,7%) and n=52.712 CEA (81,3%) were performed. 2,3% of CEA and 8,4% of the CAS procedures were special indications, including interventions prior to intracranial interventional procedures or other indications. Emergency procedures were included in the registry (7,44% CEA, 16,98% CAS). Results - 654[KM1] hospitals performed CEA and/or CAS in 2014 and with 648 in 2015). 282 (2015) / 297 (2014)hospitals reported <20 cases CEAs[KM2] per year (51,9% (2015) / 53,1% (2014)). 293 (2015) /280 (2014) hospitals reported < 20 CAS procedures 87,2% (2015) / 85,9% (2014)) The rates of preoperative neurological examination was 68,6% ( CEA) and 79,3% ( CAS, the postoperative rates were 58,2% (CEA) and 71,7% ( CAS). The results for stroke and death were below the AHA limit of 3% for asymptomatic carotid stenosis in both groups, with stroke/death rates of 1.76[KM3] % (2014) and 1.58% (2015) for CAS and 1.12% resp. 1.45% for CEA. In the case of contralateral stenosis the results were: 1.40% resp. 2.77% for CAS and 2.64% resp. 1.61% for CEA. In symptomatic stenosis, stroke/death rates for CAS were 3,5% (2014) and 3.91% (2015). CEA resulted in stroke/death rates of 2.35% resp.2.55%. The ratio observed/expected for severe stroke and death rose from 1.00 to 1.41 in the case of CAS, with values for 1.0 and 1.03 for CEA (2014 vs. 2015). Conclusion - The percentage of CAS (18% ) in the population did not change in the last two years. Both methods resulted in acceptable results for treatment of asymptomatic stenosis on a national scale. Risk adjustement was done to make individual hospitals comparable. There were differences in indications: CAS was more often used in acute stroke and in combination with intracranial procedures. CEA was also performed in combination with ACBG; the results of simultaneous ACBG and CEA were poor and reached unacceptable high stroke/death rates. The interpretation of these registry data is somewhat limited due to missing follow-up data as well as due to the fact the the data sets were pooled, and therefore a detailed statistical comparison was not possible.