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Outcomes After Carotid Artery Stenting and Endarterectomy in the Medicare Population
Fen Wei Wang, Dennis Esterbrooks, Yong-Fang Kuo, Aryan Mooss, Syed M. Mohiuddin, and Barry F. Uretsky
Stroke. 2011;42:2019-2025
Background and Purpose—Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for stroke
prevention. The value of this therapy relative to CEA remains uncertain.
Methods—In 10 958 Medicare patients aged 66 years or older between 2004 and 2006, we analyzed in-hospital, 1-year
stroke, myocardial infarction, and death rate outcomes and the effects of potential confounding variables.
Results—CAS patients (87% were asymptomatic) had a higher baseline risk profile, including having a higher percentage
of coronary and peripheral arterial disease, heart failure, and renal failure. In-hospital stroke rate (1.9% CAS versus
1.4% CEA; P0.14) and mortality (CAS 0.9% versus 0.6% CEA; P0.20) were similar. By 1 year, CAS patients had
similar stroke rates (5.3% CAS versus 4.1% CEA; P0.12) but higher all-cause mortality rates (9.9% CAS versus 6.1%
CEA; P0.001). Using Cox multivariable models, there was a similar stroke risk (hazard ratio, 1.28; 95% CI,
0.90 –1.79) but CAS patients had a significantly higher mortality (HR, 1.32; 95% CI, 1.02–1.71). Sensitivity analyses
suggested that unmeasured confounders could be responsible for the mortality difference. In multivariable analysis,
stroke risk was highest in the patients symptomatic at the time of revascularization.
Conclusions—CAS patients had a similar stroke risk but an increased mortality rate at 1 year compared with CEA patients,
possibly related to the higher baseline risk profile in the CAS patient group.

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