Society for Vascular Surgery (SVS) vascular registry® evaluation of age-stratified comparative effectiveness of carotid endarterectomy (CEA) and Carotid Artery Stenting (CAS)

Objectives: Recent randomized controlled trials have shown that age significantly affects the outcome of carotid revascularization. The purpose of this study is to utilize data from the SVS Vascular Registry® (VR) to report the influence of age on the comparative effectiveness of CEA and CAS. Methods: VR collects provider-reported patient-data using a web-based database. Patients were stratified based on age and symptomatology. The primary endpoint was the composite of death, stroke and myocardial infarction (MI) at 30-days. Results: As of 12/7/10, there were 1347-CEA and 861-CAS <65 years and 4169-CEA and 2536 CAS > = 65years. In both age groups, CAS was more likely to have radiation or restenosis for disease etiology, be symptomatic, and have higher cardiac comorbidities. In > = 65years, CAS had higher rates of mortality (1.97% vs 0.91%, p<0.01), stroke (4.89% vs 2.52%, p<0.01) and the combined death/stroke/MI (7.14% vs 4.27%, p<0.01). In <65years, the primary endpoint (5.23% CAS vs 3.56% CEA, p = 0.065) approached statistical significance. Further analyses showed that CAS in > = 65years was associated with higher primary outcome rate in both symptomatic (9.52% vs 5.27%, p<0.01) and asymptomatic (5.27% vs 3.31%, p<0.01) subgroups. For <65years, CAS had higher combined death/stroke/MI (4.44% vs 2.10%, p<0.031) in asymptomatics but no difference in symp-tomatics (6.00% vs 5.47%, p = 0.79). After risk adjustment (Table presented) (Table 1), CAS. >= 65years were more likely to reach the primary endpoint Conclusions: Compared to CEA, CAS resulted in inferior 30-day outcomes in symptomatic and asymptomatic patients <= 65years.