Presentation (CTI)

OBJECTIVES: Carotid artery disease (CAD) is a leading cause of preventable stroke, especially among older adults. Transfemoral carotid artery stenting (TF-CAS) and transcarotid artery revascularization (TCAR) are minimally invasive treatment options that have emerged as alternatives to traditional carotid endarterectomy, but research on their impact to hospital length of stay (LOS) is limited. This study compared the hospital LOS associated with TF-CAS and TCAR in Medicare patients with CAD.
METHODS: Data from the Medicare 100% Standard Analytical Files were used to identify patients aged 65+ with CAD who underwent TF-CAS or TCAR between January 1, 2022 and December 31, 2023. Eligibility was restricted to patients with at least three months of continuous Medicare Fee-for-Service enrollment pre-procedure. LOS was defined as the duration of the inpatient procedural admission. Unpaired t-tests and Wilcoxon-Mann-Whitney tests were used to compare mean and median LOS, respectively.
RESULTS: The cohort included 17,067 TF-CAS and 8,255 TCAR patients, with a mean age of 75.4, a mean Charlson Comorbidity Index score of 2.79, and a primarily White (91.4%) and male (62.5%) demographic. Across the study period, TCAR was associated with statistically significantly lower mean (2.36 ± 3.47 vs. 2.96 ± 4.20 days, p<0.0001) and median LOS (1 [interquartile range (IQR): 1-2] vs. 1 [IQR: 1-3] days, p<0.0001). Stratified by year, the results remained consistent, with TCAR associated with shorter LOS than TF-CAS in both 2022 (mean: 2.44 vs. 2.99; median: 1(1-2) vs. 1(1-3), p<0.0001) and 2023 (mean: 2.31 vs. 2.94; median: 1(1-2) vs. 1(1-3), p<0.0001).
CONCLUSIONS: TCAR is associated with shorter hospital LOS than TF-CAS in Medicare patients with CAD, indicating greater procedural efficiency and reduced resource utilization. While this suggests potential cost savings, further research is needed to quantify economic impacts and assess clinical outcomes. These results support TCAR as a patient-centered approach with promising implications for individuals and healthcare systems.