• Hans-Henning Eckstein, Pavlos Tsantilas, Andreas Kühnl, Bernhard Haller, Thorben Breitkreuz, Alexander Zimmermann, and Michael Kallmayer.
• Department of Vascular and Endovascular Surgery/Vascular Center, Klinikum rechts der Isar der Technischen Universität München; Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München; AQUA-Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen.
• Dtsch Arztebl Int. 2017 Oct 27; 114 (43): 729736729-736.

BackgroundCarotid endarterectomy (CEA) and carotid artery stenting (CAS) can be used to prevent stroke due to arteriosclerotic lesions of the carotid artery. In Germany, legally mandated quality assurance (QA) enables the evaluation of outcome quality after CEA and CAS performed under routine conditions.MethodsWe analyzed data on all elective CEA and CAS procedures performed over the periods 2009-2014 and 2012-2014, respectively. The endpoints of the study were the combined in-hospital stroke and death rate, stroke rate and mortality separately, local complications, and other complications. We analyzed the raw data with descriptive statistics and carried out a risk-adjusted analysis of the association of clinically unalterable variables with the risk of stroke and death. All analyses were performed separately for CEA and CAS.ResultsData were analyzed from 142 074 CEA procedures (67.8% of them in men) and 13 086 CAS procedures (69.7% in men). The median age was 72 years (CEA) and 71 years (CAS). The periprocedural rate of stroke and death after CEA was 1.4% for asymptomatic and 2.5% for symptomatic stenoses; the corresponding rates for CAS were 1.7% and 3.7%. Variables associated with increased risk included older age, higher ASA class (ASA = American Society of Anesthesiologists), symptomatic vs. asymptomatic stenosis, 50-69% stenosis, and contralateral carotid occlusion (for CEA only).ConclusionThese data reveal a low periprocedural rate of stroke or death for both CEA and CAS. This study does however not permit any conclusions as to the superiority or inferiority of CEA and CAS.

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