Carotid Artery Stenting Linked to High Mortality Rate

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Carotid stenting is associated with a high mortality risk in Medicare patients, according to an analysis published in JAMA Neurology.

Researchers found that there was an alarming 32% mortality rate among those in the CMS carotid artery stenting database (CAS-D) from 2005 to 2009, while the CREST trial had an 11.3% mortality rate after two and a half years and the SAPPHIRE trial had a rate of 20% after three years.

Symptomatic patients aged at least 80 years had a 46% mortality rate two years after the procedure­ – the highest in the Medicare data group. The researchers noted that competing risks can limit the benefit of carotid artery stenting in older symptomatic patients who have high long-term mortality risks.

"It is tempting to conclude that the high mortality seen in the CMS stented cohort can be explained by a combination of advanced age and poorly controlled cardiovascular disease risk factors, as well as the inclusion of a sicker group of patients," wrote Mark J. Alberts, MD, of the University of Texas Southwestern Medical Center, in a review. "Indeed, this is the most likely scenario."

However, it’s too early to rule out other possibilities such as how the stenting process could trigger a release of inflammatory or toxic factors that could influence the rate of cardiovascular events, including death. Of those included in the Medicare data, 85% listed either ischemic heart disease, heart failure or cancer as cause of death.

Stent
Carotid Artery Stenting Linked to High Mortality Rate

Carotid stenting was associated with much higher than expected 2-year mortality in the Medicare population, a national analysis found.

That rate was 32% in the CMS carotid artery stenting database (CAS-D) from 2005 to 2009, Soko Setoguchi, MD, DrPH, of the Duke Clinical Research Institute, and colleagues reported online in JAMA Neurology.

In the CREST trial, mortality was 11.3% after a median follow-up of 2.5 years. In SAPPHIRE, it was 20% after 3 years. The researchers concluded that those trials might have limited generalizability to the Medicare population and called for real-world effectiveness studies comparing the percutaneous treatment to surgery and to medical management.

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