Research Activities, January 2011: Outcomes/Effectiveness Research: Treatment for blocked carotid arteries varies depending on where you live

Outcomes/Effectiveness Research
Treatment for blocked carotid arteries varies depending on where you live

Blocked carotid arteries in the neck can lead to stroke. Yet, if you are an elderly Medicare patient, the treatment you receive to relieve this blockage may depend on what U.S. region you live in, reveals a new study. One treatment, carotid endarterectomy (CEA), involves surgery to remove the blockage. Another approach, carotid stenting (CAS), involves insertion of a stainless steel tube to prop the artery open, and is typically used for patients at high surgical risk from CEA. During the period 2003-2004, there was a ninefold difference between the highest rate of CAS (7.17 per 1,000 person-years in Beaumont, TX) and the lowest rate (0.82 per 1,000 person-years in Honolulu, HI). By 2005-2006, this geographic variation in CAS had diminished to 5.5 per 1,000 person-years in Beaumont and 0.79 per 1,000 person-years in Honolulu. Rates of CAS showed geographic variations, but these were less pronounced than for CEA. Overall, the New England, Mountain, and Pacific regions had the lowest rates of these procedures, while the four Central regions tended to have the highest revascularization rates.

The researchers also found that men and patients previously diagnosed with peripheral vascular disease were more likely to undergo CEA, while CAS was more common among patients with a previous diagnosis of coronary artery disease or who had a prior CEA. The findings were based on data from the Centers for Medicare & Medicaid Services for all elderly Medicare beneficiaries who underwent carotid endarterectomy or carotid stenting from January 1, 2003, through December 31, 2006. State of residence was used to group beneficiaries into nine U.S. Census regions. The study was funded in part by the Agency for Healthcare Research and Quality (Contract No. 290-05-0032).

More details are in "Geographic variation in carotid revascularization among Medicare beneficiaries, 2003-2006," by Mamesh R. Patel, M.D., Melissa A. Greiner, M.S., Lisa D. DiMartino, M.P.H., and others in the July 26, 2010, Archives of Internal Medicine 170(14), pp. 1218-1225.
Research Activities, January 2011: Outcomes/Effectiveness Research: Treatment for blocked carotid arteries varies depending on where you live