Background:
Carotid artery stenting (CAS) has evolved into a viable alternative for the treatment of symptomatic and asymptomatic high-grade 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 stage 5 chronic kidney disease (CKD) (GFR<15 mL/min/1.73 m
2
or dialysis) 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. Baseline clinical characteristics and outcomes were identified in patients with stage 5 CKD. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as the composite of in-hospital death, acute myocardial infarction and acute cerebrovascular accident (CVA).
Results:
Our study population consisted of 1,723 patients that underwent CEA and 544 patients that underwent CAS. Patients undergoing CAS were younger and had significantly lower rates of coronary artery disease, hypertension and hyperlipidemia. CAS patients experienced significantly higher rates of MACCE compared with patients that underwent CEA, mainly driven by a higher rate of in-hospital strokes (Fig. 1). In a multivariable analysis, CAS (OR 1.53, 95% CI 1.19-1.98) was an independent predictor of MACCE.
Conclusions:
In patients with stage 5 CKD (GFR<15 mL/min/1.73 m
2
or dialysis ) undergoing internal carotid artery revascularization, CAS was associated with higher rates of in-hospital MACCE, driven by higher mortality and stroke rates when compared with CEA.
THE IMPACT OF AGE ON THE OUTCOMES AFTER CAROTID ARTERY STENTING OR ENDARTERECTOMY IN PATIENTS WITH MODERATE OR SEVERE CHRONIC KIDNEY DISEASE (STAGE 3 AND 4): INSIGHTS OF THE HEALTHCARE COST AND UTILIZATION PROJECT’S NATIONAL INPATIENT SAMPLE
