title: Changes in the use of carotid revascularization among the medicare population.
abstract: OBJECTIVE
  It remains unknown if the increasing use of carotid artery stenting (CAS) has caused a change in the population-based use of carotid endarterectomy (CEA). We sought to examine national trends in carotid revascularization.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Academic research.
  
  
  METHODS
  All Medicare beneficiaries (MCBEs) between January 1, 1998, through December 31, 2004.
  
  
  METHODS
  We examined the frequency of CEA and CAS using Current Procedural Terminology codes for CEA, peripheral stent insertion, and cerebrovascular disease. To exclude patients who underwent stenting of a peripheral artery other than the carotid artery, we excluded all patients with a primary diagnostic code for peripheral vascular disease.
  
  
  RESULTS
  We identified 134 194 claims for carotid revascularization (9386 claims for CAS and 124 808 claims for CEA). The overall incidence of carotid revascularization procedures decreased slightly between 1998 and 2004, from 388.1 to 345.8 procedures per 100 000 MCBEs (11% decrease, P < .02). Between 1998 and 2004, the incidence of CEA decreased from 373.4 to 309.3 procedures per 100 000 MCBEs (17% decrease, P < .01), while the incidence of CAS increased from 14.6 to 36.4 procedures per 100 000 MCBEs (149% increase, P < .01).
  
  
  CONCLUSIONS
  While rates of carotid revascularization in the Medicare population slightly decreased between 1998 and 2004, the use of CAS dramatically increased. Whether this represents a substitution of CAS for CEA vs a broadening of indications for carotid revascularization using CAS is unknown but is of interest to patients and third-party payers and requires future investigation.
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03766, USA. philip.goodney@hitchcock.org
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.forename: F Lee
authors.initials: FL
authors.lastname: Lucas
authors.forename: Lori L
authors.initials: LL
authors.lastname: Travis
authors.forename: Donald S
authors.initials: DS
authors.lastname: Likosky
authors.forename: David J
authors.initials: DJ
authors.lastname: Malenka
authors.forename: Elliott S
authors.initials: ES
authors.lastname: Fisher
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005544:Forecasting; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015607:Stents; D016019:Survival Analysis; D018608:Ultrasonography, Doppler; D014481:United States