Otite FO, et al. - National patterns in carotid artery stenting (CAS) performance were evaluated in patients older than 70 years in the post-Carotid Revascularization Endarterectomy vs Stenting Trial (CREST)(2011-2014) compared with the pre-CREST (2007-2010) era. In patients older than 70 years, the odds of CAS increased in the post-CREST compared with pre-CREST era, including symptomatic women, despite concerns about higher periprocedural complications with CAS.

Methods

• The researchers retrospectively identified all adults older than 70 years undergoing carotid revascularization in the United States from 2007 to 2014 from the 2007-2014 National Inpatient Sample using International Classification of Disease, Ninth Revision procedural codes.
• Using International Classification of Disease, Ninth Revision procedural codes, 494,733 weighted carotid revascularization admissions in adults older than 70 years were identified from 61,324,882 unweighted hospitalizations contained in the 2007-2014 National Inpatient Sample.
• They estimated the proportion of CAS performed in all age groups over time.
• They used multivariable-adjusted models to compare the odds of receiving CAS in the pre-CREST with those in the post-CREST era in adults older than 70 years.

Results

• Among the study participants, 41.8% were women, and mean (SE) age at presentation was 78.1 (0.03) years.
• The researchers performed 16.3% of CAS and 10.1% of CEA procedures in patients with symptomatic stenosis.
• The proportion of patients older than 70 years receiving CAS increased from 11.9% in the pre-CREST to 13.8% in the post-CREST era (P=.005).
• Compared with the pre-CREST period, the odds of receiving CAS increased by 13% in all patients older than 70 years in the post-CREST peroid (odds ratio [OR], 1.13, 95% CI, 1.00-1.28, P=.04), including symptomatic women (OR, 1.31, 1.05-1.65, P=.02) in multivariable models.
• Factors associated with higher odds of CAS were symptomatic stenosis (OR 1.39; 95% CI, 1.27-1.52; P < .001), congestive heart failure (OR, 1.48; 95% CI, 1.35-1.63; P < .001), and peripheral vascular disease (OR, 1.35; 95% CI, 1.27-1.43; P < .001).
• Comorbid hypertension (OR, 0.70; 95% CI, 0.66-0.74; P < .001), smoking (OR, 0.84; 95% CI, 0.78-0.91; P < .001), and weekend admission (OR, 0.77; 95% CI, 0.68-0.88; P < .001) were negatively correlated with the odds of CAS.