Background:
CREST, a randomized trial comparing carotid artery stenting (CAS) with endarterectomy (CEA) in symptomatic and asymptomatic patients, reported in 2010 that the two procedures were similar for the composite endpoint of stroke, myocardial infarction, or death. Data on temporal trends in the use of these procedures in the US are limited, particularly by sex, race, and geographic region. We reviewed trends in utilization of CAS and CEA for ischemic stroke patients.
Methods:
Ischemic stroke hospitalizations (ICD-9 433, 434, 436) were identified for patients aged ≥18 years from the Nationwide Inpatient Sample 2007-2011 (N=480,375). Annual trends of CAS and CEA were estimated using mixed models that adjusted for patient age and comorbidities. Models were stratified by sex, race (white, black, other), and 9 geographic regions.
Results:
Overall, the proportion of stroke patients who received CAS remained relatively stable over time (2.7% in 2007 to 2.8% in 2011) while the proportion who received CEA decreased (from 21.0% to 16.3%). CAS rates increased in the three Central Regions (East North, East South, and West South) but decreased in New England; CEA declines were similar across regions. In adjusted analyses, CAS rates increased slightly for white men, decreased for men and women of other race, but remained stable for the remaining groups (Figure); CEA rates decreased for all sex-race groups. These patterns by sex and race subgroups were generally consistent across geographic regions.
Conclusions:
The proportion of hospitalized stroke patients receiving CEA decreased over time while CAS rates remained relatively stable, with slight increases seen in the Central regions of the US. There are sex-race differences in the proportion of patients who receive these procedures, but these patterns are largely similar across regions.
Impact of baseline characteristics on outcomes of carotid artery stenting in acute ischemic stroke patients
