Odds for carotid artery stenting in seniors up post-CREST era

(HealthDay)—The odds of carotid artery stenting (CAS) have increased in the post-Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) era, despite safety concerns for patients older than 70 years, according to a study published online Dec. 4 in JAMA Neurology.

Fadar Oliver Otite, M.D., from the University of Miami Miller School of Medicine, and colleagues examined national patterns in CAS performance in patients older than 70 years in the post- versus pre-CREST era (2011 to 2014 versus 2007 to 2010).

The researchers observed a significant increase in the proportion of patients older than 70 years receiving CAS, from 11.9 percent in the pre-CREST to 13.8 percent in the post-CREST era. Compared with the pre-CREST era, in the post-CREST era, the odds of receiving CAS increased in all patients older than 70 years (odds ratio, 1.13), including symptomatic women (odds ratio, 1.31). Higher odds of CAS were seen in association with symptomatic stenosis, congestive heart failure, and peripheral vascular disease (odds ratios, 1.39, 1.48, and 1.35, respectively); negative associations were seen for comorbid hypertension, smoking, and weekend admission (odds ratio, 0.70, 0.84, and 0.77, respectively).

"Despite concerns for higher periprocedural complications with CAS in elderly patients, the odds of CAS increased in the post-CREST compared with pre-CREST era in patients older than 70 years, including symptomatic women," the authors write.