Introduction: Several randomized controlled clinical studies published over the past decade, primarily the 2010 Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), have shown that carotid endarterectomy (CEA) remains the treatment of choice for carotid artery stenosis over carotid artery stenting (CAS), particularly in patients without surgical contraindications. Despite these findings, utilization trends have shown an increase in CAS procedures and a decrease in CEA surgeries. The aim of this study is to examine the most current trend in CAE versus CAS in the United States following the publication of the CREST study recommendations.

Methods: Data was obtained from the Agency for Healthcare Research and Quality (AHRQ) website: Healthcare Cost and Utilization Project (HCUPnet). This is the largest set of public all-payer healthcare databases in the United States. Data was extracted by obtaining discharge records from 2005 to 2010 and from 2011 to 2012 for patients using the ICD-9-CM CEA procedure code of 38.12, and the CAS procedure code of 00.63. Subgroup analysis was conducted to evaluate the trends in utilization using patient specific demographic data including gender, age, and payer source.

Results: Between 2005-2010, the rate of CAS increased from 12.4% to 14.5%, in 2011-2012, for all carotid procedures (p<0.0001). During the same period, there was a statistically significant decrease in the rate of CEA cases from 87.6% to 85.5% for carotid stenosis (p<0.0001). There was no significant difference in the rate of CAS or CEA treatment in any age group studied (p>0.05).

Conclusions: CEA remains the treatment of choice for patients diagnosed with carotid artery stenosis, however this analysis suggests a decrease in this treatment modality during this period. Further study is needed to evaluate the socioeconomic impact of the current trends on the treatment of carotid artery stenosis.

Patient Care: Understanding the utilization of treating carotid artery disease, will allow us to re-evaluate the best methods for treatment and analyze patient outcomes. The current treatment recommendations might not be reflected in the current trend for carotid artery disease.

Learning Objectives: 1. Review the conclusions of the CREST trial. 2. Demonstrate the impact of the CREST trial on treating carotid stenosis. 3. Show the current utilization trends for carotid artery stenting and carotid endarterectomy.

References: Brott, T. G., Hobson, R. W., 2nd, Howard, G., Roubin, G. S., Clark, W. M., Brooks, W., . . . Investigators, C. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med, 363(1), 11-23. doi: 10.1056/NEJMoa0912321