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Philip P. Goodney, MD, MS; F. Lee Lucas, PhD; Donald S. Likosky, PhD; David J. Malenka, MD, MS; Elliott S. Fisher, MD, MPH

Arch Surg. 2008;143(2):170-173.

Hypothesis  It remains unknown if the increasing use of carotid artery stenting (CAS) has caused a change in the population-based use of carotid endarterectomy (CEA). We sought to examine national trends in carotid revascularization.

Design  Retrospective cohort study.

Setting  Academic research.

Patients  All Medicare beneficiaries (MCBEs) between January 1, 1998, through December 31, 2004.

Main Outcome Measures  We examined the frequency of CEA and CAS using Current Procedural Terminology codes for CEA, peripheral stent insertion, and cerebrovascular disease. To exclude patients who underwent stenting of a peripheral artery other than the carotid artery, we excluded all patients with a primary diagnostic code for peripheral vascular disease.

Results  We identified 134 194 claims for carotid revascularization (9386 claims for CAS and 124 808 claims for CEA). The overall incidence of carotid revascularization procedures decreased slightly between 1998 and 2004, from 388.1 to 345.8 procedures per 100 000 MCBEs (11% decrease, P < .02). Between 1998 and 2004, the incidence of CEA decreased from 373.4 to 309.3 procedures per 100 000 MCBEs (17% decrease, P < .01), while the incidence of CAS increased from 14.6 to 36.4 procedures per 100 000 MCBEs (149% increase, P < .01).

Conclusions  While rates of carotid revascularization in the Medicare population slightly decreased between 1998 and 2004, the use of CAS dramatically increased. Whether this represents a substitution of CAS for CEA vs a broadening of indications for carotid revascularization using CAS is unknown but is of interest to patients and third-party payers and requires future investigation.

Author Affiliations: Section of Vascular Surgery (Dr Goodney) and Department of Cardiology (Dr Malenka), Dartmouth-Hitchcock Medical Center, Lebanon, and Center for Evaluative Clinical Sciences (Drs Likosky, Malenka, and Fisher), Dartmouth Medical School, Hanover, New Hampshire; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland (Dr Lucas); and Veterans Affairs (VA) Outcomes Group, VA Medical Center, White River Junction, Vermont (Dr Fisher).

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