To evaluate the safety and cost of carotid stenting in Calgary.
A cost-utility analysis from the perspective of the Canadian health care system was performed comparing stenting to endarterectomy using a decision analytic model.
A prospective cohort study was done for trans cranial Doppler monitoring during stenting procedures. Findings were correlated with 24-hour MRI brain lesions using a binomial regression model.
Stenting was more expensive than endarterectomy ($6106.84 incremental cost) and had a lower effectiveness (- 0.12 QALYs). Results were influenced by the procedure costs and were sensitive to patients’ characteristics.
In 26 subjects who underwent stenting, MRI lesions were detected in 76%. Procedural monitoring showed a median of 224.5 emboli. Large emboli correlated with MRI lesions after adjusting for age and symptoms status.
To improve the outcomes of carotid stenting, research should aim to improve the procedure safety without increasing its costs.