Carotid Artery Stenting Trends in Elderly Patients
Higher odds of CAS were seen in association with symptomatic stenosis, congestive heart failure, and peripheral vascular disease.
HealthDay News — The odds of carotid artery stenting (CAS) have increased in the post-Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) era, despite safety concerns for patients older than 70 years, according to a study published online in JAMA Neurology.
Fadar Oliver Otite, MD, from the University of Miami Miller School of Medicine, and colleagues examined national patterns in CAS performance in patients older than 70 years in the post- versus pre-CREST era (2011-2014 vs 2007-2010).
The researchers observed a significant increase in the proportion of patients older than 70 years receiving CAS, from 11.9% in the pre-CREST to 13.8% in the post-CREST era.
Compared with the pre-CREST era, in the post-CREST era, the odds of receiving CAS increased in all patients older than 70 years (OR, 1.13), including symptomatic women (OR, 1.31). Higher odds of CAS were seen in association with symptomatic stenosis, congestive heart failure, and peripheral vascular disease (OR, 1.39, 1.48, and 1.35, respectively); negative associations were seen for comorbid hypertension, smoking, and weekend admission (OR, 0.70, 0.84, and 0.77, respectively).
"Despite concerns for higher periprocedural complications with CAS in elderly patients, the odds of CAS increased in the post-CREST compared with pre-CREST era in patients older than 70 years, including symptomatic women," the authors write.
Otite FO, Khandelwal P, Malik AM, Chaturvedi S. National patterns of carotid revascularization before and after the carotid revascularization endarterectomy vs stenting trial (CREST) [published online December 4, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2017.3496