Changing Trends in Carotid Revascularization in Australia: A Nationwide Study Over 30 Years.

Abstract

Background: Carotid artery stenosis is one of the causes of acute ischaemic stroke. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the main procedural treatment options. This study investigates the changing trends in carotid revascularisation in Australia over the last 30 years.

Methods: Two population level datasets were used, the Australian Institute of Health and Welfare (AIHW) and Medicare Australia. Patients who had either CEA or CAS procedures between 1993 and 2024 were identified, and procedural trends were analyzed over a 30-year period.

Results: Data from AIHW was available from 2000 to 2021, over which 66 983 patients underwent carotid revascularisation (58 932 CEA and 8051 CAS). There was a 47.4% relative decrease in the absolute number of CEA procedures over the study period (3702-1948). There was a relative 23.1% increase in CAS procedures over this period (524-645). Data from the Medicare dataset was available from 1993 until 2024, over which 41 860 patients had carotid revascularisation (38 118 CEA and 3742 CAS). There was a relative 51.0% decrease in the absolute number of CEA procedures (1733-849). There was a 1.6% relative decrease in the absolute number of CAS procedures over the study period (187-184).

Conclusion: The number of carotid revascularisation procedures performed has steadily decreased over the last 30 years. CEA procedures have declined to a greater extent compared to CAS procedures, though CEA procedures remain significantly more common. These trends likely reflect evolving medical therapy for carotid artery disease.