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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
American Journal of Neuroradiology – American Journal of Neuroradiology
Published: Jan 1, 2011
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