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Does Current Practice in the United States of Carotid Artery Stent Placement Benefit Asymptomatic Octogenarians?

Does Current Practice in the United States of Carotid Artery Stent Placement Benefit Asymptomatic... This Article Free to Access Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A2253v1 ajnr.A2253v2 32/1/170 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Young, K. C. Articles by Jahromi, B. S. PubMed PubMed Citation Articles by Young, K. C. Articles by Jahromi, B. S. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 32:170-173, January 2011 © 2011 American Society of Neuroradiology INTERVENTIONAL Does Current Practice in the United States of Carotid Artery Stent Placement Benefit Asymptomatic Octogenarians? K.C. Young a and B.S. Jahromi a a From the Departments of Neurology (K.C.Y.), Surgery (K.C.Y.), Neurosurgery (B.S.J.), and Imaging Sciences (B.S.J.), University of Rochester Medical Center, Rochester, New York. Please address correspondence to Kate C. Young, PhD, MPH, URMC Stroke Center, 601 Elmwood Ave, Box 681, Rochester, NY 14642; e-mail: kate_young@urmc.rochester.edu BACKGROUND AND PURPOSE: CAS or CEA for asymptomatic carotid stenosis is the focus of recently completed and ongoing randomized clinical trials. These techniques are widely utilized outside the setting of such trials. Therefore, our goal was to analyze the in-hospital stroke or death rates after CAS or CEA for asymptomatic stenosis that reflect current nationwide practice. MATERIALS AND METHODS: Using sample-weighted ANOVA, we analyzed records from the 2006 and 2007 NIS, which are nationally representative cohorts for asymptomatic CAS or CEA. The primary outcome measure was a composite end point of in-hospital stroke, cardiac complications, or death. In-hospital stroke or death was a secondary outcome measure. RESULTS: For 80 years of age, the in-hospital stroke, cardiac complications, or death rate after CAS was 4.9%, while the complication rate after CEA was 3.8%. The stroke or death rate after CAS was 2.7% for 80 years of age and was 1.5% after CEA for the same age group. Multivariate analysis showed that age (OR, 1.12; 95% CI, 0.97–1.3; P < .07) or procedure (OR, 1.12; 95% CI, 0.99–1.27; P < .14) was not associated with the composite end point of in-hospital stroke, cardiac complications, or death. In contrast, CAS (OR, 1.28; 95% CI, 1.03–1.58) and female sex (OR, 1.23; 95% CI, 1.04–1.45) were independently associated with in-hospital stroke or death following asymptomatic carotid revascularization. Hospital charges and hospital costs were lower for CEA than CAS (2007 costs: $7779 versus $12,104). CONCLUSIONS: CAS is independently associated with increased in-hospital stroke or death (excluding cardiac complications from the composite outcome). In those 80 years of age, CAS as currently performed may not improve the natural history of asymptomatic carotid stenosis, because in-hospital stroke or death rates following CAS approached 3% in this group. Abbreviations: ACAS, Asymptomatic Carotid Atherosclerosis Study • ACST, Asymptomatic Carotid Surgery Trial • ANOVA, analysis of variance • CAS, carotid artery stenting • CC, cardiac complications • CEA, carotid endarterectomy • CHF, congestive heart failure • CI, confidence interval • COPD, chronic obstructive pulmonary disease • CREST, Carotid Revascularization Endarterectomy vs. Stenting Trial • ICD-9, International Classification of Disease, Version 9 • MI, myocardial infarction • NIS, Nationwide Inpatient Sample • NS, not significant after multivariate analysis • OR, odds ratio • OXVASC, Oxford Vascular Study • SE, standard error • SEM, standard error of the mean Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2011 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Does Current Practice in the United States of Carotid Artery Stent Placement Benefit Asymptomatic Octogenarians?

American Journal of Neuroradiology , Volume 32 (1): 170 – Jan 1, 2011

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2011 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A2253
Publisher site
See Article on Publisher Site

Abstract

This Article Free to Access Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A2253v1 ajnr.A2253v2 32/1/170 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Young, K. C. Articles by Jahromi, B. S. PubMed PubMed Citation Articles by Young, K. C. Articles by Jahromi, B. S. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 32:170-173, January 2011 © 2011 American Society of Neuroradiology INTERVENTIONAL Does Current Practice in the United States of Carotid Artery Stent Placement Benefit Asymptomatic Octogenarians? K.C. Young a and B.S. Jahromi a a From the Departments of Neurology (K.C.Y.), Surgery (K.C.Y.), Neurosurgery (B.S.J.), and Imaging Sciences (B.S.J.), University of Rochester Medical Center, Rochester, New York. Please address correspondence to Kate C. Young, PhD, MPH, URMC Stroke Center, 601 Elmwood Ave, Box 681, Rochester, NY 14642; e-mail: kate_young@urmc.rochester.edu BACKGROUND AND PURPOSE: CAS or CEA for asymptomatic carotid stenosis is the focus of recently completed and ongoing randomized clinical trials. These techniques are widely utilized outside the setting of such trials. Therefore, our goal was to analyze the in-hospital stroke or death rates after CAS or CEA for asymptomatic stenosis that reflect current nationwide practice. MATERIALS AND METHODS: Using sample-weighted ANOVA, we analyzed records from the 2006 and 2007 NIS, which are nationally representative cohorts for asymptomatic CAS or CEA. The primary outcome measure was a composite end point of in-hospital stroke, cardiac complications, or death. In-hospital stroke or death was a secondary outcome measure. RESULTS: For 80 years of age, the in-hospital stroke, cardiac complications, or death rate after CAS was 4.9%, while the complication rate after CEA was 3.8%. The stroke or death rate after CAS was 2.7% for 80 years of age and was 1.5% after CEA for the same age group. Multivariate analysis showed that age (OR, 1.12; 95% CI, 0.97–1.3; P < .07) or procedure (OR, 1.12; 95% CI, 0.99–1.27; P < .14) was not associated with the composite end point of in-hospital stroke, cardiac complications, or death. In contrast, CAS (OR, 1.28; 95% CI, 1.03–1.58) and female sex (OR, 1.23; 95% CI, 1.04–1.45) were independently associated with in-hospital stroke or death following asymptomatic carotid revascularization. Hospital charges and hospital costs were lower for CEA than CAS (2007 costs: $7779 versus $12,104). CONCLUSIONS: CAS is independently associated with increased in-hospital stroke or death (excluding cardiac complications from the composite outcome). In those 80 years of age, CAS as currently performed may not improve the natural history of asymptomatic carotid stenosis, because in-hospital stroke or death rates following CAS approached 3% in this group. Abbreviations: ACAS, Asymptomatic Carotid Atherosclerosis Study • ACST, Asymptomatic Carotid Surgery Trial • ANOVA, analysis of variance • CAS, carotid artery stenting • CC, cardiac complications • CEA, carotid endarterectomy • CHF, congestive heart failure • CI, confidence interval • COPD, chronic obstructive pulmonary disease • CREST, Carotid Revascularization Endarterectomy vs. Stenting Trial • ICD-9, International Classification of Disease, Version 9 • MI, myocardial infarction • NIS, Nationwide Inpatient Sample • NS, not significant after multivariate analysis • OR, odds ratio • OXVASC, Oxford Vascular Study • SE, standard error • SEM, standard error of the mean Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2011 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Jan 1, 2011

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