LAUSR

Background: Centers of Medicare and Medicaid Services (CMS) has defined a set of high-risk criteria to help define patients who would likely benefit from CAS over CEA. The purpose of this study was to evaluate the postoperative outcomes in patients undergoing CAS vs. CEA, and whether those outcomes vary based on the CMS high-risk criteria. Methods: All patients undergoing CAS or CEA recorded in the Vascular Quality Initiative database (2013-2016) were included. Patients were stratified as being normal-risk (Nr) or high-risk (Hr) for undergoing CEA based on published CMS criteria. 30-day and 2-year outcomes [stroke, myocardial infarction (MI), death] were compared for CAS vs. CEA in both the Nr and Hr groups using 1:1 coarsened exact matching and multivariable Cox proportional hazards modelling. Results: A total of 55,765 patients (CAS=8,538; CEA=47,227) underwent carotid revascularization during the study period. A significantly higher proportion of CAS were classified as being Hr (75.1% vs. 38.5%; P Conclusions: In this matched cohort of patients, CAS carries a persistently higher risk of stroke/death than CEA regardless of operative risk. However, the performance difference between the two procedures dissipates in the Hr patients. Thus, CAS utilization should be considered in this group.