Benefit of Carotid Stenting in Elderly Called Into Question
(HealthDay News) — Mortality risk in older Medicare patients who undergo carotid artery stenting is high, according to a report published online January 12 in JAMA Neurology.
Soko Setoguchi-Iwata, MD, DrPH, an assistant professor of medicine at Harvard Medical School in Boston, and colleagues collected data on 22,516 Medicare patients, average age 76, who had carotid artery stenting between 2005–2009.
Within 30 days after the procedure, 1.7% of the patients died, 3.3% suffered a stroke or transient ischemic attack, and 2.5% had a myocardial infarction, the researchers found. Two years later, 32.0% of the patients died. The death rate was highest among those with symptoms, such as plaque in the artery (37.3%), and lowest among those without symptoms (27.7%). In addition, patients who were at least 80 years old and who did not have the surgery as an elective procedure were among those with the greatest risk of dying.
Previous studies have estimated that carotid artery stenting reduces the risk of stroke by 5–16% over five years, Setoguchi-Iwata told HealthDay. But this study suggests the real benefit is not as great. The high death rate is likely due to these patients' advanced age and other medical conditions, Setoguchi-Iwata said. "Another potential contributing factor is that the proficiency of the real-world providers of carotid stenting likely vary, whereas trial providers had to meet certain proficiency criteria."