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

Sponsored Content | Videos | Cath Lab | October 24, 2018
Michael Flaherty, M.D., discusses a study published in Circulation Research which finds that use of hemodynamic suppo
Philips Showcases Integrated Solutions for Cardiovascular Care at TCT 2018
News | Cath Lab | September 20, 2018
At the Transcatheter Cardiovascular Therapeutics (TCT) annual meeting, Sept. 21–25 in San Diego, Philips is showcasing...
Sponsored Content | Videos | Cath Lab | September 19, 2018
William O’Neill, M.D., outlines his recent clinical publication of AMICS patients from the Impella Quality (IQ) datab
A complex PCI case to revascularize a chronic total occlusion (CTO) at Henry Ford Hospital in Detroit. Complex PCI and CHIP cases are increasing patient volumes in the cath lab and using a minimally invasive approach in patients who otherwise would have been sent for CABG. Pictured is Khaldoon Alaswad, M.D. DAIC staff photo by Dave Fornell

A complex PCI case to revascularize a chronic total occlusion (CTO) at Henry Ford Hospital in Detroit. Complex PCI and CHIP cases are increasing patient volumes in the cath lab and using a minimally invasive approach in patients who otherwise would have been sent for CABG. Pictured is Khaldoon Alaswad, M.D. (right) who is proctoring a fellow in treating CTOs.

Feature | Cath Lab | September 13, 2018 | Artur Kim, Kamran Zamanian
Coronary artery disease (CAD) is a multifaceted disease that demands various approaches in terms of diagnosis and tre
Videos | Cath Lab | August 13, 2018
Jeffrey Schussler, M.D., FACC, FSCAI, FSCCT, FACP, interventional cardiologist at Baylor Scott White Heart and Vascul
Shockwave Launches Coronary Intravascular Lithotripsy in Europe
News | Cath Lab | May 30, 2018
Shockwave Medical recently announced the European commercial availability of Intravascular Lithotripsy (IVL) for...
FFR software on the GE Centricity CVIS. A trial from the 2018 EuroPCR meeting showed FFR improves long-term outcomes.
News | Cath Lab | May 29, 2018
May 29, 2018 — Ongoing controversy exists regarding the role of percutaneous coronary intervention (PCI) for stable c
Overlay Init