Early Outcomes after Carotid Endarterectomy and Carotid Artery Stenting for Carotid Stenosis in the ACS-NSQIP Database

Abstract

Background—Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are both viable treatment
options for carotid artery stenosis. We sought to compare perioperative outcomes after CEA and CAS for
the management of carotid stenosis using a “real-world” sample.
Methods—We conducted a retrospective observational study using the National Surgical Quality
Improvement Program database to compare 30-day (periprocedural) outcomes in patients with carotid
stenosis undergoing CEA versus CAS from 2005 to 2012. Baseline characteristics and periprocedural outcomes including stroke, myocardial infarction, mortality and combined outcome (composite of any stroke,
myocardial infarction, or death) were compared.
Results—A total of 54,640 patients were identified who underwent CEA and 488 who underwent CAS.
Patients undergoing CEA were more likely to be older and have symptomatic stenosis, and less likely to be
white, have congestive heart failure, and have chronic obstructive pulmonary disease. There were no significant differences between CEA and CAS in periprocedural mortality (0.9% vs. 1.2%, p = 0.33), stroke
(1.6% vs. 1.6 p = 0.93), myocardial infarction (0.9% vs. 1.6%, p = 0.08), or combined outcome (3.0% vs.
4.9%, p = 0.09). The interaction between symptomatic status and procedure type was not significant, indicating the association of symptomatic status with 30-day mortality (p = 0.29) or the combined periprocedural outcome (p = 0.57) were similar in cases receiving CEA and CAS.
Conclusion—Early outcomes after CEA and CAS for carotid artery stenosis appear to be similar in a
“real-world” sample and comparable to clinical trials. Patients undergoing CAS were more likely to be
younger and surgically have higher risk based on baseline characteristics likely reflecting clinical practice
case selection.