(Stroke. 1995;26:1724-1728.)
© 1995 American Heart Association, Inc.
Articles |
Epidemiology of Carotid Endarterectomy and Cerebral Arteriography in the United States
From the Centers for Disease Control and Prevention, Hyattsville, Md.
Background and Purpose Results of North American and European trials of carotid endarterectomy published in 1991 may have affected the frequency of the procedure in the United States. Therefore, data from a national survey of hospital discharges were examined to determine whether rates of carotid endarterectomy and arteriography increased after 1991 and whether race and sex variations in rates have persisted.
Methods Data from the National Hospital Discharge Survey were examined for the years 1980 through 1993. Estimated numbers of procedures performed in nonfederal US hospitals were used to compute rates per 100 000 population by year, age, race, and sex.
Results In persons aged 65 years and over, the rate of carotid endarterectomy increased rapidly between 1980 and 1983 with a slight further increase through 1985. A marked fall in the rate occurred between 1985 and 1988, followed by a plateau and a sharp upturn in 1992. After 1985, there was a steady decline in the rate of cerebral arteriography procedures in hospital. No reliable data were available on outpatient cerebral arteriography. Throughout the period, whites had estimated rates of carotid endarterectomy procedures over four times higher than blacks. Whites also had higher rates of cerebral arteriography, but the disparity was not as great as for endarterectomy. Rates of carotid endarterectomy were 60% higher in men than women, but rates of cerebral arteriography were only 9% higher in men than women.
Conclusions Rates of carotid endarterectomy increased sharply after the 1991 publication of trial results. Marked racial disparities in the use of this procedure persist and require further evaluation.
Key Words: blacks • carotid endarterectomy • cerebral angiography • clinical trials • women
This article has been cited by other articles:
 |
|
 |
|
  R. C. Pasternak, M. H. Criqui, E. J. Benjamin, F. G. R. Fowkes, E. M. Isselbacher, P. A. McCullough, P. A. Wolf, and Z.-J. Zheng Atherosclerotic Vascular Disease Conference: Writing Group I: Epidemiology Circulation, June 1, 2004; 109(21): 2605 - 2612. [Full Text] [PDF]
|
|
|
|
 |
|
 U.G.R. Schulz and P.M. Rothwell Differences in Vascular Risk Factors Between Etiological Subtypes of Ischemic Stroke: Importance of Population-Based Studies Stroke, August 1, 2003; 34(8): 2050 - 2059. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Sheikh and C. Bullock Sex differences in carotid endarterectomy utilization and 30-day postoperative mortality Neurology, February 11, 2003; 60(3): 471 - 476. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. L. Hannan, A. J. Popp, P. Feustel, E. Halm, G. Bernardini, J. Waldman, D. Shah, and M. R. Chassin Association of Surgical Specialty and Processes of Care With Patient Outcomes for Carotid Endarterectomy Stroke, December 1, 2001; 32(12): 2890 - 2897. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Ayerdi, L. N. Sampson, N. Deshmukh, A. Farid, and S. K. Gupta Carotid Endarterectomy in Patients with Renal Insufficiency: Should Selection Criteria be Different in Patients with Renal Insufficiency? Vascular and Endovascular Surgery, November 1, 2001; 35(6): 429 - 435. [Abstract] [PDF]
|
|
|
|
|
|
T. E. Feasby, H. Quan, W. A. Ghali, and J. M. Findlay Geographic Variation in the Rate of Carotid Endarterectomy in Canada Editorial Comment Stroke, October 1, 2001; 32(10): 2417 - 2422. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. P. Gross, C. A. Steiner, E. B. Bass, and N. R. Powe Relation Between Prepublication Release of Clinical Trial Results and the Practice of Carotid Endarterectomy JAMA, December 13, 2000; 284(22): 2886 - 2893. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Rothwell, S. T. Pendlebury, J. Wardlaw, and C. P. Warlow Critical Appraisal of the Design and Reporting of Studies of Imaging and Measurement of Carotid Stenosis Stroke, June 1, 2000; 31(6): 1444 - 1450. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Petty, R. D. Brown Jr, J. P. Whisnant, J. D. Sicks, W. M. O’Fallon, and D. O. Wiebers Ischemic Stroke Subtypes : A Population-Based Study of Incidence and Risk Factors Stroke, December 1, 1999; 30(12): 2513 - 2516. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Gorelick Carotid Endarterectomy : Where Do We Draw the Line? Stroke, September 1, 1999; 30(9): 1745 - 1750. [Full Text] [PDF]
|
|
|
|
|
|
J. H. Wong, T. B. Lubkey, M. E. Suarez-Almazor, and J. M. Findlay Improving the Appropriateness of Carotid Endarterectomy : Results of a Prospective City-Wide Study Stroke, January 1, 1999; 30(1): 12 - 15. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. V. Tu, E. L. Hannan, G. M. Anderson, K. Iron, K. Wu, K. Vranizan, A. J. Popp, and K. Grumbach The Fall and Rise of Carotid Endarterectomy in the United States and Canada N. Engl. J. Med., November 12, 1998; 339(20): 1441 - 1447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kasirajan, R. Obermeyer, M. K. Hirko, J. J. Turner, and J. R. Rubin Synchronous Management of Incidental Neck Masses and Carotid Artery Disease Vascular and Endovascular Surgery, November 1, 1998; 32(6): 531 - 534. [Abstract] [PDF]
|
|
|
|
|
|
T. S. Huber, K. G. Wheeler, J. K. Cuddeback, D. A. Dame, T. C. Flynn, and J. M. Seeger Effect of the Asymptomatic Carotid Atherosclerosis Study on Carotid Endarterectomy in Florida Stroke, June 1, 1998; 29(6): 1099 - 1105. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. G. Holloway Jr, D. M. Witter Jr, A. I. Mushlin, K. B. Lawton, M. P. McDermott, and G. P. Samsa Carotid Endarterectomy Trends in the Patterns and Outcomes of Care at Academic Medical Centers, 1990 Through 1995 Arch Neurol, January 1, 1998; 55(1): 25 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Karp, W. D. Flanders, C. C. Shipp, B. Taylor, and D. Martin Carotid Endarterectomy Among Medicare Beneficiaries : A Statewide Evaluation of Appropriateness and Outcome Stroke, January 1, 1998; 29(1): 46 - 52. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. S. Huber, P. W. Durance, A. Kazmers, and L. A. Jacobs Effect of the Asymptomatic Carotid Atherosclerosis Study on Carotid Endarterectomy in Veterans Affairs Medical Centers Arch Surg, October 1, 1997; 132(10): 1134 - 1139. [Abstract] [PDF]
|
|
|
|
|
|
J. H. Wong, J. M. Findlay, and M. E. Suarez-Almazor Regional Performance of Carotid Endarterectomy : Appropriateness, Outcomes, and Risk Factors for Complications Stroke, May 1, 1997; 28(5): 891 - 898. [Abstract] [Full Text]
|
|
|
|
|
|
J. E. Thompson The Evolution of Surgery for the Treatment and Prevention of Stroke: The Willis Lecture Stroke, August 1, 1996; 27(8): 1427 - 1434. [Full Text]
|
|
|
|
|
|
H. G. Beebe The Carotid Angioplasty Premise Vascular and Endovascular Surgery, July 1, 1996; 30(4): 269 - 273. [PDF]
|
|
|
|
|
|
L. B. Goldstein, A. J. Bonito, D. B. Matchar, P. W. Duncan, and G. P. Samsa US National Survey of Physician Practices for the Secondary and Tertiary Prevention of Ischemic Stroke : Carotid Endarterectomy Stroke, May 1, 1996; 27(5): 801 - 806. [Abstract] [Full Text]
|
|