JAMA logoPatients suffering with a blockage in carotid arteries may either be subjected to endarterectomy surgery or stent placement. Astonishingly, researchers claim that variation in a region is the deciding factor of the type of treatment for this ailment. While people from some parts of the United States are more likely to receive the surgery, patients from other parts are probably receiving stents for the same ailment.

Investigations comparing stents and endarterectomy in patients were apparently able to report mixed results for heart attack, stroke and death. For determining the patterns in the employment of stents or endarterectomy, researchers examined patients aged 65 and older from the Centers for Medicare & Medicaid Services from Jan. 1, 2003, through Dec. 31, 2006. Rates of carotid endarterectomy seemingly decreased among Medicare beneficiaries. The decline appeared from 3.2 per 1,000 patients per year to 2.6 per 1,000 patients per year.

The researchers enlightened, “Carotid endarterectomy has been the recommended treatment for patients with extracranial carotid artery disease since the publication of several randomized studies in the 1990s comparing carotid endarterectomy with medical therapy.”

After adjusting for demographic and clinical characteristics, a significant geographic variation was found in the odds of revascularization by Manesh R. Patel, M.D., of Duke University School of Medicine, Durham, N.C., and colleagues. Codes for stenting were registered by data prepared in 2005. 0.3 procedures were conducted on per 1,000 patients that year, on the other hand, 0.4 per 1,000 patients were provided with stents in the following year.

Patients belonging to the New England, Mountain regions like Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah and Wyoming and Pacific such as Alaska, California, Hawaii, Oregon and Washington were least likely to go through both procedures. Whereas those from the East South Central including Alabama, Kentucky, Mississippi and Tennessee, East North Central namely Illinois, Indiana, Michigan, Ohio and Wisconsin and West North Central regions like Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and South Dakota had the highest possibility.

The investigators affirmed, “Significant geographic variation was seen in the use of carotid endarterectomy and carotid stenting among Medicare beneficiaries and variation in the carotid imaging modalities used before revascularization. Moreover, men and patients with a prior diagnosis of peripheral vascular disease were more likely to undergo carotid revascularization, and patients with a prior diagnosis of coronary artery disease or a prior carotid endarterectomy were more likely to undergo carotid stenting. These findings suggest that the development of consensus regarding clinical criteria for carotid imaging, such as a national standard for appropriate use criteria, is required.”

Around nine-fold variation in between the highest and lowest rate of endarterectomy across regions in 2003 and 2004 and a seven-fold difference in 2005 and 2006 was registered. 30 days after undergoing endarterectomy, 1.2 percent of patients died in 2005. Amongst patients facing carotid stenting 10.3 percent were unable to survive for more than a year.

The research is published in the July 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.