Carotid endarterectomy (CEA) yields better short-term results than carotid artery stenting (CAS) in patients with carotid artery disease, according to a 30-day outcomes report from the Society for Vascular Surgery (SVS) Vascular Registry for Carotid Procedures, published in the January 2009 issue of the Journal of Vascular Surgery, by the Society for Vascular Surgery.
Carotid artery disease is marked by stenosis (narrowing) of the carotid artery, located on either side of the neck, which supplies blood to the brain. Typically, this has been treated by performing an open repair surgery (CEA). An endovascular procedure (CAS) treats patients who are at risk for complications such as prior carotid artery surgery (i.e., CEA), neurological conditions (i.e., prior stroke), or exposure to radiation at the neck.
The SVS Outcomes Committee developed the Vascular Registry for Carotid Procedures in response to the 2005 Centers for Medicare and Medicaid Services National Coverage Decision on carotid artery stenting. The SVS Vascular Registry went live on July 2005, as the first societal registry to enroll CAS and CEA patients. Data are allocated to visit intervals of 30-day, six-month, one-year, and subsequent annual evaluations.
"As of December 26, 2007, 6,403 procedures with discharge data were entered by 287 providers at 56 centers," said Flora Siami, MPH, director, regulatory affairs and principal research scientist at New England Research Institutes, Inc. in Watertown, Mass. "In addition there were 1,450 CAS patients and 1,368 CEA patients with 30-day outcomes."
"Our primary outcome of interest was combined death, stroke, and myocardial infarction at 30-days post-procedure," said senior author Anton Sidawy, MD, MPH, FACS, chief of vascular surgery at Veterans Affair Medical Center in Washington, D.C. and professor of surgery at both Georgetown and George Washington University Schools of Medicine, in Washington, D.C. "The SVS Outcomes Committee also reviewed demographics, comorbidities, intra-operative complications."
"The majority of patients were treated because of atherosclerotic disease," said Dr. Sidawy. "In general, there was a greater proportion of CAS patients with pre-procedure lateralizing neurological symptoms, as well as higher prevalence of cardiac comorbidities compared with CEA patients."