Feature | Stents Carotid | July 13, 2015

Study Finds Wide Variation in Carotid Artery Stenting Outcomes

Odds of suffering stroke or death differ by about 50 percent from one facility to another

carotid artery stenting, outcomes, JACC, Beau Hawkins, Robert Yeh, CARE Registry

July 13, 2015 - Hospitals performing carotid artery stenting vary considerably in rates of in-hospital stroke or death, according to a study published in JACC: Cardiovascular Interventions. Those rates can range from 0 to 18 percent overall, and from 1.2 to 4.7 percent when accounting for variation in health of patients at admission.

Using data from the American College of Cardiology's CARE Registry, the largest national registry of carotid artery stent patients, researchers assessed 19,381 procedures from 188 hospitals that each performed more than five carotid artery stenting procedures between 2005 and 2013. The study was led by Beau M. Hawkins, M.D., a cardiologist at the University of Oklahoma Health Sciences Center, and Robert W. Yeh, M.D., a cardiologist at the Massachusetts General Hospital.

Carotid artery stenting is a procedure that involves inserting a mesh stent to hold open an artery after a blockage is cleared. 

For patients with similar risk profiles, the odds of suffering stroke or death differ by about 50 percent from one facility to another, pointing to a substantial range in quality among hospitals performing this procedure, according to the study authors.

Results showed that the average rate of stroke or death across all patients in the study was 2.4 percent, with death or stroke rates among participating hospitals ranging from 0 to 18.8 percent. Variation is common with many cardiovascular procedures because some hospitals treat sicker patients, which could explain poorer outcomes in those facilities.

To account for differences in the patient mix, researchers did a second analysis that adjusted for variation in risk factors, including age, prior stroke, impending major surgery, and the presence of a heart flutter. Adjusted death and stroke rates ranged from 1.2 percent to 4.7 percent.    

Unlike other studies, this analysis did not find a connection between procedural volume and outcomes. The authors suggest that this difference may be the result of therapeutic advances such as blood-clot protection devices and improved patient selection. They also speculate that hospitals participating in this study may have more comprehensive measures in place to promote patient safety, or they may have more rigorous credentialing standards for providers performing carotid artery stenting. 

Hawkins and Yeh noted that "our findings are important because they demonstrate that carotid stenting is being performed with good results across a large number of hospitals in the United States. However, our analyses also suggest that some hospitals are achieving better outcomes than others, and it will be important to identify the reasons for this so that all centers offering this therapy can achieve exceptional outcomes."  

For more information: www.acc.org

Related Content

Most Stable Ischemic Heart Disease Patients Did Not Meet ISCHEMIA Trial Enrollment Criteria, raising questions about its application in real-world practice. #SCAI2021 Getty Images

Getty Images

News | Cath Lab | May 03, 2021
May 3, 2021 – Results from a new study find a broad range of patients who typically undergo revascularization for sta
New study demonstrates depression, HIV, mental health, obesity, alcohol and drug abuse are risk factors on most common type of heart disease in young black patients. Photo by Dave Fornell
News | Cath Lab | April 29, 2021
April 29, 2021 – A retrospective analysis of risk factors for coronary artery disease (CAD) in young African American
SCAI 2021 late-breaking presentations included the data on the Medtronic Harmony transcatheter pulmonary valve, cutting radial access hemostasis time by 50 percent, improving cardiogenic shock survival to 71 percent, and data showing very high mortality in COVID patients who suffer a STEMI heart attack. #SCAI21 #SCAI2021

SCAI 2021 late-breaking presentations included the data on the Medtronic Harmony transcatheter pulmonary valve, cutting radial access hemostasis time by 50 percent, improving cardiogenic shock survival to 71 percent, and data showing very high mortality in COVID patients who suffer a STEMI.

Feature | Cath Lab | April 29, 2021
April 29, 2021 — Here is the list of late-breaking study presentations and links to articles about each of them from
There are far fewer patients coming to hospitals with heart attacks during the COVID-19 pandemic as compared to averages prior to the pandemic. This has raised concerns that delayed treatment will cause an uptick in cardiac deaths and heart failure. Photo from Getty Images 

There are far fewer patients coming to hospitals with heart attacks during the COVID-19 pandemic as compared to averages prior to the pandemic. This has raised concerns that delayed treatment will cause an uptick in cardiac deaths and heart failure. Photo from Getty Images 

News | Cath Lab | April 28, 2021
April 28, 2021 – Results from a retrospective observational study, presented today at...
A cardiac cath lab at Henry Ford Hospital in Detroit. Photo by Dave Fornell

A cardiac cath lab complex PCI case at Henry Ford Hospital in Detroit. Photo by Dave Fornell

News | Cath Lab | April 28, 2021
Videos | Cath Lab | April 02, 2021
Corindus, a Siemens Healthineers company and a developer of vascular robotics, recently launched a new set of automat
Videos | Cath Lab | March 31, 2021
This is a quick example of clinical use of the Shockwave Medical Intravascular Lithotripsy system that uses sonic wav

SpectraWave is developing a a new intravascular imaging system that combines two currently available modalities. This likely includes optical coherence tomography (OCT), left, which can define structures within the vessel and vessel wall.  Near infrared spectroscopy (NIRS), right, enables a spectral chemical analysis of the vessel walls to show areas of high lipid content, and specifically can identify lipid-core plaques that are associated with heart attack-causing plaque ruptures.

News | Cath Lab | February 16, 2021
February 16, 2021 – SpectraWave Inc.
Videos | Cath Lab | February 04, 2021
Cindy Grines, M.D., MSCAI, FACC, president