Importance  The Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) showed greater safety of carotid artery stenting (CAS) in patients younger than 70 years and carotid endarterectomy (CEA) in those older than 70 years. It is unknown how the result of CREST has influenced carotid revascularization choices in the United States.

Objective  To evaluate national patterns in CAS performance in patients older than 70 years in the post-CREST (2011-2014) compared with the pre-CREST (2007-2010) era.

Design, Setting, and Participants  All adults older than 70 years undergoing carotid revascularization in the United States from 2007 to 2014 were retrospectively identified from the 2007-2014 National Inpatient Sample using International Classification of Disease, Ninth Revision procedural codes. From 61 324 882 unweighted hospitalizations contained in the 2007-2014 National Inpatient Sample, 494 733 weighted carotid revascularization admissions in adults older than 70 years were identified using International Classification of Disease, Ninth Revision procedural codes.

Main Outcomes and Measures  The proportion of CAS performed in all age groups over time was estimated and multivariable-adjusted models were used to compare the odds of receiving CAS in the pre-CREST with those in the post-CREST era in adults older than 70 years.

Results  A total of 41.8% of all patients were women, and mean (SE) age at presentation was 78.1 (0.03) years. A total of 16.3% of CAS and 10.1% of CEA procedures were performed in patients with symptomatic stenosis. The proportion of patients older than 70 years receiving CAS increased from 11.9% in the pre-CREST to 13.8% in the post-CREST era (P = .005). In multivariable models, the odds of receiving CAS increased by 13% in all patients older than 70 years in the post-CREST compared with the pre-CREST period (odds ratio [OR], 1.13, 95% CI, 1.00-1.28, P = .04), including symptomatic women (OR, 1.31, 1.05-1.65, P = .02). Symptomatic stenosis (OR 1.39; 95% CI, 1.27-1.52; P < .001), congestive heart failure (OR, 1.48; 95% CI, 1.35-1.63; P < .001), and peripheral vascular disease (OR, 1.35; 95% CI, 1.27-1.43; P < .001) were associated with higher odds of CAS; comorbid hypertension (OR, 0.70; 95% CI, 0.66-0.74; P < .001), smoking (OR, 0.84; 95% CI, 0.78-0.91; P < .001), and weekend admission (OR, 0.77; 95% CI, 0.68-0.88; P < .001) were negatively associated with the odds of CAS.

Conclusions and Relevance  Despite concerns for higher periprocedural complications with CAS in elderly patients, the odds of CAS increased in the post-CREST compared with pre-CREST era in patients older than 70 years, including symptomatic women.

重要性  颈动脉血运重建术与支架试验（CREST）显示，对于70岁以下的患者和70岁以上的患者，颈动脉支架置入术（CAS）的安全性更高。尚不清楚CREST的结果如何影响美国的颈动脉血运重建选择。

目的  评价与CREST之前（2007-2010年）相比，CREST之后（2011-2014年）对70岁以上患者CAS表现的国家模式。

设计，环境和参与者  从2007-2014年美国住院患者样本中，使用《国际疾病分类》（第九修订版）程序对2007年至2014年在美国进行颈动脉血运重建术的所有70岁以上的成年人进行了回顾性鉴定。根据《国际疾病分类，第九修订版》程序，从2007-2014年国家住院患者样本中包含的61 324 882例未加权住院中，确定了70岁以上成年人中494 733例加权颈动脉血运重建入院。

主要结果和措施  估算了随时间推移在所有年龄组中进行CAS的比例，并使用多变量调整模型比较了70岁以上成年人在CREST之前和CREST后时代接受CAS的几率。 。

结果  共有41.8％的患者为女性，出现时的平均（SE）年龄为78.1（0.03）岁。有症状的狭窄患者共进行了16.3％的CAS和10.1％的CEA手术。70岁以上接受CAS的患者比例从CREST前的11.9％增加到CREST后的13.8％（P  = .005）。在多变量模型中，与CREST之前的时期相比，CREST之后所有70岁以上的患者接受CAS的几率比CREST之前的时期增加了13％（赔率[OR]，1.13、95％CI，1.00-1.28，P  = .04），包括有症状的女性（OR，1.31，1.05-1.65，P  = .02）。有症状的狭窄（OR 1.39; 95％CI，1.27-1.52; P <.001），充血性心力衰竭（OR，1.48; 95％CI，1.35-1.63; P  <.001）和周围血管疾病（OR，1.35; 95％CI，1.27-1.43; P  <.001）与CAS的较高赔率相关; 合并症高血压（OR，0.70; 95％CI，0.66-0.74; P  <.001），吸烟（OR，0.84; 95％CI，0.78-0.91; P  <.001），以及周末入院（OR，0.77; 95） ％CI，0.68-0.88；P  <.001）与CAS的几率呈负相关。

结论与相关性  尽管担心老年患者CAS的围手术期并发症更高，但对于有症状的70岁以上患者，与CREST前相比，CREST后CAS发生几率高于CREST前时代。