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Use of carotid endarterectomy (CEA) has waxed and waned since the 1980s in response to studies that showed benefits only in carefully selected symptomatic patients and associated inappropriate use in asymptomatic patients with substantial comorbidity. Use of carotid angioplasty and stenting (CAS) also has been variable and possibly inappropriate, given that this procedure is approved only for symptomatic patients at high surgical risk.
In a study based on Medicare administrative claims from 2003 through 2006, researchers examined use of CEA in about 320,000 patients and CAS in about 19,000 patients. The rate of CEA usage declined by 19% — from 3.2/1000 person-years in 2003 to 2.6/1000 person-years in 2006. CAS use rose 33% — from 0.3/1000 pe…