Rates of restenosis (defined by duplex ultrasound INCB018424 in vitro imaging at the 1-year follow-up) were estimated using life-table analysis. Cox proportional hazards models were used to identify multivariable predictors of postoperative

restenosis <= 1 year.

Results: Across 58 surgeons and 11 hospitals, we studied 2611 conventional CEAs (88% of all CEAs) and 370 eversion CEAs (12% of all CEAs). Median follow-up was 12.8 months (range, 1-35 months). The proportion of conventional CEAs performed with patching increased from 87% to 96% (P < .001) between 2003 and 2008, whereas eversion CEA declined from 18% to 5% (P < .001). Restenosis occurred in 303 patients (10%); by life-table analysis, the restenosis rate at 1 year was 6.2% (95% confidence interval [CI], 4.7%-6.8%). Restenoses were most commonly noncritical: 50%-79% restenosis in 7.9%, 80%-99% restenosis in 1.7%, and occlusion in 0.5%. Univariate analyses showed significant differences in 80% to 100% restenosis by procedure type (2% in conventional CEA, 6% in eversion CEA, P < .002), the year of procedure (3.2% in 2003, 0% in 2008; P <

.03), and use of patching in conventional CEA (2.9% no patch, 1% with patch; P < .008). By multivariable analysis, absence of patching (hazard ratio [HR], 3.2; 95% CI, 1.5-7.0), contralateral internal carotid artery stenosis >80% (HR, 4.1; 95% CI, 1.4-11.5), and dialysis dependence (HR, 3.5; 95% CI, click here 1.2-9.8) were independently associated with a higher risk of an 80% to 100% restenosis. Of the 51 patients with 80% to 99% restenosis, 14 underwent reintervention <= 1 year, comprising 4 reoperations and 10 carotid artery stent procedures. Of the 15 patients with a carotid occlusion <= 1 year, transient ischemic attacks occurred in 2 and a disabling stroke in 1.

Conclusions: In our region, restenosis after CEA, especially clinically significant restenosis <= 1 year after surgery, decreased slightly over time. This improvement in outcome was associated with several

factors, including an increase in patching after conventional Gemcitabine price CEA, a process of care that was studied and encouraged within our vascular study group. These results highlight the utility of regional quality-improvement efforts in improving outcomes in vascular surgery. (J Vase Surg 2010;52:897-905.)”
“Background: Despite the current Centers for Medicare and Medicaid Services coverage criteria for carotid artery stenting (CAS), consensus regarding its appropriateness in patients with carotid artery stenosis has not been reached. This is one of the first population-based studies to use a dedicated administrative convention for the endovascular procedure to address whether there is a cohort of patients in whom CAS is more beneficial than carotid endarterectomy (CEA).