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Comment & Response
January 16, 2018

Trends in Carotid Revascularization Procedures

Author Affiliations
  • 1Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, England
JAMA. 2018;319(3):308. doi:10.1001/jama.2017.19769

To the Editor In a study of Medicare beneficiaries during 1999-2014,1 30-day ischemic stroke or death rates after carotid endarterectomy improved (from 4.4% in 1999-2000 to 3.1% in 2013-2014), as did all-cause mortality (from 1.6% to 1.1%). In contrast, 30-day ischemic stroke or death rates after carotid artery stenting did not differ between the beginning and the end of the study period (7.0% in 1999-2000 and 7.0% in 2013-2014) and neither did all-cause mortality (4.7% in 1999-2000 and 4.8% in 2013-2014).1 Importantly, 30-day ischemic stroke or death rates after carotid artery stenting were higher than those recommended by the American Heart Association/American Stroke Association (AHA/ASA) guidelines (<6% for symptomatic patients and <3% for asymptomatic patients).2,3 This finding was not discussed by the authors.1

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