title: The practice of carotid revascularization in a large metropolitan population.
abstract: Carotid endartectomy (CEA) and carotid artery stenting (CAS) reduce the risk of stroke when performed with acceptable perioperative morbidity and mortality. Studies from the 1980s in the greater Cincinnati/northern Kentucky population showed that perioperative risk after CEA exceeded the recommended boundaries of 3.0% for asymptomatic stenosis and 6.0% for symptomatic stenosis. We investigated the indications and outcomes for CEA and CAS in the same population during 2005. We identified all residents of the greater Cincinnati/northern Kentucky region who underwent CEA or CAS at any local hospital during 2005. Identified cases of transient ischemic attack or stroke occurring before or after CEA or CAS were abstracted by study nurses and reviewed by a study physician. The main outcome of interest was 30-day risk of stroke or death after CEA or CAS. Events were analyzed using Kaplan-Meier statistics. Among approximately 1.3 million greater Cincinnati/northern Kentucky residents, 525 CEAs were performed, 343 (65%) for asymptomatic stenosis and 182 (35%) for symptomatic stenosis. There were 43 CAS procedures, 23 (53%) for asymptomatic stenosis and 20 (47%) for symptomatic stenosis. The 30-day perioperative risk of stroke or death after CEA was 3.3% (95% confidence interval [CI], 1.8%-5.9%) for asymptomatic stenosis and 6.3% (95% CI, 3.5%-11.1%) for symptomatic stenosis. The 30-day perioperative risk of stroke or death after CAS was 4.6% (95% CI, 0.7%-28.1%) for asymptomatic stenosis and 21.1% (95% CI, 8.5%-46.8%) for symptomatic stenosis. Point estimates for perioperative risk after CEA were improved from previous studies but remained above the recommended benchmarks. The number of CAS procedures was low, but the perioperative risk was significant.
authors: Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio 45267-0525, USA. matthew.flaherty@uc.edu
authors: Matthew L
authors: ML
authors: Flaherty
authors: Brett
authors: B
authors: Kissela
authors: Heidi
authors: H
authors: Sucharew
authors: Kathleen
authors: K
authors: Alwell
authors: Charles J
authors: CJ
authors: Moomaw
authors: Daniel
authors: D
authors: Woo
authors: Pooja
authors: P
authors: Khatri
authors: Simona
authors: S
authors: Ferioli
authors: Opeolu
authors: O
authors: Adeoye
authors: Jason
authors: J
authors: Mackey
authors: Joseph P
authors: JP
authors: Broderick
authors: Dawn
authors: D
authors: Kleindorfer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002548:Cerebral Revascularization / Q000401:mortality / Q000706:statistics & numerical data*; D016894:Endarterectomy, Carotid / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D020521:Stroke / Q000401:mortality* / Q000601:surgery*; D014505:Urban Population / Q000706:statistics & numerical data