title: Uptake of carotid artery stenting in England and subsequent vascular admissions: an appropriate response to emerging evidence?
abstract: OBJECTIVE
  We report the uptake, length of stay and vascular readmission rates of carotid endarterectomy (CEA) and CAS among patients with symptomatic or asymptomatic carotid artery disease in the English National Health Service (NHS).
  
  
  METHODS
  Retrospective cohort study based on routinely collected Hospital Episode Statistics (HES) inpatient data. We identified individual admissions for CEA (n = 15996) or CAS (n = 632) between 2006 and 2009. Summary data were used to describe procedure volumes between 2009 and 2012. We analysed trends in procedure use over time and used ordinary least squares regression to evaluate patient, clinical and organisational characteristics associated with longer length of stay for revascularisation.
  
  
  RESULTS
  CAS made up less than 5% of carotid revascularisation procedures; there was no trend for increasing use between 2006 and 2012. Patients treated with CAS were on average younger, lived in areas of higher deprivation and were more likely to have amaurosis fugax or a comorbidity of heart disease. CAS patients had a 19% (95% CI 14-24) shorter stay in hospital than CEA patients.
  
  
  CONCLUSIONS
  Despite the early promise of CAS and numerous randomised controlled trials evaluating efficacy, it has not been rapidly adopted in England. Cautious adoption may be appropriate given the higher periprocedural risk of stroke or death after CAS, particularly in recently symptomatic patients.
authors.affiliation: Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK. al9436@my.bristol.ac.uk
authors.forename: A H Y
authors.initials: AH
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Busby
authors.forename: M
authors.initials: M
authors.lastname: Brooks
authors.forename: W
authors.initials: W
authors.lastname: Hollingworth
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D016894:Endarterectomy, Carotid; D004739:England / Q000453:epidemiology; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016018:Least-Squares Analysis; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents
keywords: Carotid stenosis; Endarterectomy; Hospital episode statistics; Stenting; Uptake