Determining patient preference for treatment of extracranial carotid artery stenosis: Carotid angioplasty and stenting versus carotid endarterectomy

Revascularization of extracranial carotid artery stenosis (ECAS) continues to be the subject of spirited academic debate. Conflicting studies in the literature have fostered uncertainty among patients choosing between CEA and CAS. We obtained preference-based utilities from prospective patients being evaluated for ECAS and incorporated them into a decision analytic model. Patients being evaluated for ECAS in an outpatient setting were interviewed prior to their initial visit with a vascular surgeon. Patient preference data were elicited using probability trade-off (PTO) assessment and time trade-off (TTO) method. Decision analysis was performed to compare CEA with CAS. Morbidity and mortality rates were obtained from recent literature reports from the same institution. Our results showed that when patients are informed, they prefer and will more often choose CEA over CAS for revascularization of ECAS. Among patients preferring CAS, they expect no more than a 46% increase in the rate of stroke and/or death. Future clinical studies on true stroke rates for CAS will be required to further refine this analysis.