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Print this pageClinical Outcomes And Cost Comparison Of Carotid Artery Angioplasty With Stenting Versus Carotid Endarterectomy For Cerebrovascular Disease
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Brian D. Park, MD, Arun Mavanur, MD, Michael Dahn, MD, PhD, James Menzoian, MD, Melih Arici, MD.
The University of Connecticut Health Center, Farmington, CT, USA.
Objectives: Recently, carotid angioplasty with stenting (CAS) has evolved as an alternative modality to carotid endarterectomy (CEA). Concerns have arisen regarding the high cost of stents and distal protection devices. We report here a review and analysis of the clinical outcomes and associated costs for our patients treated with either CAS or CEA.
Methods: 78 consecutive patients suffering from surgically amenable carotid
stenosis were offered CAS or CEA. 39 Patients elected CAS, and 39 patients underwent CEA. CAS was performed with distal protection in the angiography suite. CEA was performed in the operating room with Dacron patches. Clinical outcomes such as peri-operative mortality, major adverse events (MI, stroke, and death), length of admission, and hemodynamic instability were analyzed. Total costs associated with hospitalization, indirect costs,and direct costs were also reviewed.
Results: CAS demonstrated a shorter length of stay (1.3 vs. 2.4 days, P=.007). Differences in peri-operative mortality (0% vs. 2%, P=1.0), major adverse events (2.5% vs. 10%, P=.35), strokes (2.5% vs. 5%, P=1.0), MI (0% vs. 5%, P=.47), and hypotension requiring pressor support (25% vs. 18%, P=.79) were not statistically significant. Using cost to charge ratio methodology, CAS was associated with higher total costs ($17,402 vs. $12,112, P=.029), and direct costs ($10,522 vs. $7,227, P=.017). The difference in indirect costs was not statistically significant ($6,879 vs. $4,885, P=.063).
Conclusions: CAS with distal protection compared to CEA was associated with equivalent clinical outcomes, but higher total hospital costs. These higher costs must be taken into consideration for each individual patient.
Back to Annual Meeting
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Back to Program
Brian D. Park, MD, Arun Mavanur, MD, Michael Dahn, MD, PhD, James Menzoian, MD, Melih Arici, MD.
The University of Connecticut Health Center, Farmington, CT, USA.
Objectives: Recently, carotid angioplasty with stenting (CAS) has evolved as an alternative modality to carotid endarterectomy (CEA). Concerns have arisen regarding the high cost of stents and distal protection devices. We report here a review and analysis of the clinical outcomes and associated costs for our patients treated with either CAS or CEA.
Methods: 78 consecutive patients suffering from surgically amenable carotid
stenosis were offered CAS or CEA. 39 Patients elected CAS, and 39 patients underwent CEA. CAS was performed with distal protection in the angiography suite. CEA was performed in the operating room with Dacron patches. Clinical outcomes such as peri-operative mortality, major adverse events (MI, stroke, and death), length of admission, and hemodynamic instability were analyzed. Total costs associated with hospitalization, indirect costs,and direct costs were also reviewed.
Results: CAS demonstrated a shorter length of stay (1.3 vs. 2.4 days, P=.007). Differences in peri-operative mortality (0% vs. 2%, P=1.0), major adverse events (2.5% vs. 10%, P=.35), strokes (2.5% vs. 5%, P=1.0), MI (0% vs. 5%, P=.47), and hypotension requiring pressor support (25% vs. 18%, P=.79) were not statistically significant. Using cost to charge ratio methodology, CAS was associated with higher total costs ($17,402 vs. $12,112, P=.029), and direct costs ($10,522 vs. $7,227, P=.017). The difference in indirect costs was not statistically significant ($6,879 vs. $4,885, P=.063).
Conclusions: CAS with distal protection compared to CEA was associated with equivalent clinical outcomes, but higher total hospital costs. These higher costs must be taken into consideration for each individual patient.
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