Health related quality of life of the patients after transient ischaemic attack: is carotid endarterectomy (CEA) or carotid artery stenting (CAS) more influential?

Abstract

Although randomized trials have proven the benefit of revascularization with the use of carotid endarterectomy (CEA) or stenting (CAS) for appropriate patients, health care purchasers increasingly look beyond clinical outcome toward measures of health-related quality of life (HRQoL) in apportioning limited resources. 36 patients after TIA participated in this study. One group (n=18) had undergone CEA, whereas the second group (n=18) had undergone CAS. Both groups were matched according to age and sex. The Short Form 36 (SF-36) was used to assess the differences in patient-perceived HRQoL in two groups of patients who had suffered minor cerebral ischemic events. No significant difference in health profile between the CEA and CAS was detected for the eight SF-36 domains. However, the CEA group rated a significantly improved change in general health after one year compared with the CAS group (p<0.001). A greater proportion of the CEA group comparing to the CAS group thought their treatment had been successful and that their health had been improved (p<0.001). Both groups shared the same level of anxiety over potential future cerebral ischemic events (p=0.3). Patients' perception of HRQoL measured by the SF-36 domains was almost identical between the CEA and CAS apart from a small but significant improvement in self-reported overall health in the CEA group after one year follow up. HRQoL outcome measures may be of value in future clinical trials of cerebral revascularization to compare the effectiveness of carotid revascularization with the particular method of operation.