Park Brian, Mavanur Arun, Dahn Michael, Menzoian James
Department of Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA.
J Vasc Surg. 2006 Aug;44(2):270-6. doi: 10.1016/j.jvs.2006.04.049.
Recently, carotid angioplasty with stenting (CAS) has evolved as an alternative to carotid endarterectomy (CEA) for the treatment of carotid occlusive disease. Some concerns have arisen regarding the high cost of stents and neuroprotection devices, which may inflate the overall procedural costs relative to CEA. We report here a review and analysis contrasting the clinical outcomes and associated hospital costs incurred for patients treated with either CAS or CEA.
Ninety-four consecutive patients with surgically amenable carotid stenosis were offered CAS or CEA. Forty-six patients elected CAS, and 48 patients underwent CEA. CAS was performed with the Smart Precise or Acculink stents, and all procedures included neuroprotection (Filter Wire or Accunet). CEA was performed with patients under general anesthesia with routine shunting and with Dacron or bovine pericardium patches. Clinical outcomes such as perioperative mortality, major adverse events (myocardial infarction, stroke, and death), length of stay, and the incidence of hemodynamic instability were analyzed. Total costs, indirect costs, and direct procedural costs associated with hospitalization were also reviewed.
CAS was associated with a shorter length of stay compared with CEA (1.2 vs 2.1 days; P = .02). Differences in perioperative mortality (0% vs 2%; P = NS), major adverse events (2% vs 10%; P = .36), strokes (2% vs 4%; P = NS), myocardial infarctions (0% vs 4%; P = .49), and hypotension necessitating pressor support (21% vs 18%; P = NS) were not statistically significant. By using cost to charge ratio methodology according to the Medicare report, CAS was associated with higher total procedural costs (US dollars 17,402 vs US dollars 12,112; P = .029) and direct costs (US dollars 10,522 vs US dollars 7227; P = .017). The differences in indirect costs were not significant (US dollars 6879 vs US dollars 4885; P = .063).
CAS with neuroprotection was associated with clinical outcomes equivalent to those with CEA but had higher total hospital costs. These higher costs reflect the addition of expensive devices that have improved the technical success and the clinical outcomes associated with CAS.
近年来，颈动脉支架置入血管成形术（CAS）已发展成为治疗颈动脉闭塞性疾病的一种替代颈动脉内膜切除术（CEA）的方法。人们对支架和神经保护装置的高成本产生了一些担忧，这可能会使相对于CEA的总体手术成本增加。我们在此报告一项对比接受CAS或CEA治疗的患者的临床结局及相关住院费用的综述与分析。
向94例适合手术治疗的颈动脉狭窄患者提供CAS或CEA治疗。46例患者选择了CAS，48例患者接受了CEA。CAS使用Smart Precise或Acculink支架进行，所有手术均包括神经保护（Filter Wire或Accunet）。CEA在全身麻醉下进行，常规分流，并使用涤纶或牛心包补片。分析围手术期死亡率、主要不良事件（心肌梗死、中风和死亡）、住院时间和血流动力学不稳定发生率等临床结局。还审查了与住院相关的总成本、间接成本和直接手术成本。
与CEA相比，CAS的住院时间更短（1.2天对2.1天；P = 0.02）。围手术期死亡率（0%对2%；P = 无显著性差异）、主要不良事件（2%对10%；P = 0.36）、中风（2%对4%；P = 无显著性差异）、心肌梗死（0%对4%；P = 0.49）以及需要使用升压药支持的低血压（21%对18%；P = 无显著性差异）方面的差异无统计学意义。根据医疗保险报告采用成本与收费比率方法，CAS的总手术成本更高（17402美元对12112美元；P = 0.029），直接成本也更高（10522美元对7227美元；P = 0.017）。间接成本差异不显著（6879美元对4885美元；P = 0.063）。
具有神经保护的CAS与CEA的临床结局相当，但住院总成本更高。这些更高的成本反映了增加了昂贵的设备，这些设备提高了CAS的技术成功率和临床结局。
