{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:50:58Z","timestamp":1786323058348,"version":"build-2736575974"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Effectiveness of carotid artery stenting (CAS) relative to carotid endarterectomy (CEA) among Medicare patients has not been established. We compared effectiveness of CAS versus CEA among Medicare beneficiaries.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>We linked Medicare data (2000\u20132009) to the Society for Vascular Surgery\u2019s Vascular Registry (2005\u20132008) and the National Cardiovascular Data Registry's (NCDR) Carotid Artery Revascularization and Endarterectomy Registry (2006\u20132008\/2009). Medicare patients were followed up from procedure date until death, stroke\/transient ischemic attack, periprocedural myocardial infarction, or a composite end point for these outcomes. We derived high-dimensional propensity scores using registry and Medicare data to control for patient factors and adjusted for provider factors in a Cox regression model comparing CAS with CEA. Among 5254 Society for Vascular Surgery\u2019s Vascular Registry (1999 CAS; 3255 CEA) and 4055 Carotid Artery Revascularization and Endarterectomy Registry (2824 CAS; 1231 CEA) Medicare patients, CAS patients had a higher comorbidity burden and were more likely to be at high surgical risk (Society for Vascular Surgery\u2019s Vascular Registry: 96.7% versus 44.5%; Carotid Artery Revascularization and Endarterectomy Registry: 71.3% versus 44.7%). Unadjusted outcome risks were higher for CAS. Mortality risks remained elevated for CAS after adjusting for patient-level factors (hazard ratio, 1.24; 95% confidence interval, 1.06\u20131.46). After further adjustment for provider factors, differences between CAS and CEA were attenuated or no longer present (hazard ratio for mortality, 1.13; 95% confidence interval, 0.94\u20131.37). Performance was comparable across subgroups defined by sex and degree of carotid stenosis, but there was a nonsignificant trend suggesting a higher risk of adverse outcomes in older (&gt;80) and symptomatic patients undergoing CAS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Outcomes after CAS and CEA among Medicare beneficiaries were comparable after adjusting for both patient- and provider-level factors.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.115.002336","type":"journal-article","created":{"date-parts":[[2016,5,17]],"date-time":"2016-05-17T20:15:42Z","timestamp":1463516142000},"page":"275-285","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Comparative Effectiveness of Carotid Artery Stenting Versus Carotid Endarterectomy Among Medicare Beneficiaries"],"prefix":"10.1161","volume":"9","author":[{"given":"Jessica J.","family":"Jalbert","sequence":"first","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis L.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie D.","family":"Gerhard-Herman","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiraku","family":"Kumamaru","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Ying","family":"Chen","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren A.","family":"Williams","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Liu","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T.","family":"Rothman","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Jaff","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Seeger","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"Benenati","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Schneider","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert D.","family":"Aronow","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (H.K.); Department of Cardiology, Division of Cardiovascular Medicine, Massachusetts..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"Johnston","sequence":"additional","affiliation":[{"name":"From the Division of Pharmacoepidemiology and Pharmacoeconomics (J.J.J., H.K., C.-Y.C., L.A.W., J.L., A.T.R., J.D.S.), Vascular and Endovascular Surgery (L.L.N.), and Cardiovascular Medicine (M.D.G.-H.), Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA; LASER Analytica, New York, NY (J.J.J.); Department of Epidemiology, Harvard T.H. 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