Strokes are common these days. Endarterectomy and cleaning of the atherosclerosis is the commonest procedure done. With its mortality 1-2% and even going upto 10%, Carotid artery stenting has been found to be cost effective and safer in patients with high risk. Here is a study.

Team@CMHF

Researchers determined that carotid artery stenting (CAS) with embolic protection is an economically attractive alternative to endarterectomy (END) for patients at increased surgical risk. The study, based on data from the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial, found that initial procedural cost was higher with CAS, but post-procedure hospital stay was shorter which significantly offset associated costs compared to END.

According to the Centers for Disease Control and Prevention (CDC), stroke is the third leading cause of death and the leading cause of serious long-term disability in the U.S

Prior studies established carotid END as the standard of care for prevention of stroke in patients with carotid artery stenosis. However, the Food and Drug Administration (FDA) Circulatory System Devices Advisory Panel recently recommended expanding availability of CAS to patients with carotid artery disease at standard risk for surgical complications. The FDA recommendation and subsequent practice guidelines sponsored by 14 organizations, including SCAI, underscore the safety and efficacy of CAS as an option for patients needing revascularization

The SAPPHIRE trial included 310 patients with accepted indication for END but at high risk for complication who were then randomized and underwent CAS (n=159) or END (n=151). Researchers prospectively assessed clinical outcomes, resource use, costs and quality of life for all participants over a one-year period following the procedures.

Our findings show that CAS with embolic protection offers a cost-effective alternative treatment option for patients with carotid artery atherosclerosis who are at high risk of adverse events with END. Researchers also found after the first year, the rates of death, heart attack, major stroke and repeat carotid revascularization were lower with CAS compared with END. However, post-procedure hospital stay was one day shorter for CAS which reduced associated costs, resulting in initial costs for stenting being only $559 per patient higher than for END. Follow-up costs after discharge and total one-year costs did not differ between the two procedures. Follow-up medical costs were $810 higher for stenting.

CAS appears to be a highly cost-effective option for high surgical risk patients, “Results should not be generalized to patients at low surgical risk, however. Further studies are needed to assess efficacy and cost-effectiveness of CAS in this patient population.”

Ref: http://www.vasculardiseasemanagement.com/content/carotid-artery-stenting-shown-be-cost-effective-alternative-endarterectomy