Evolving Trends in Carotid Endarterectomy and Stenting in Australia: A 15-Year Analysis in the Post-CREST Era.

A total of 41,845 carotid interventions were performed in Australia between 2009 and 2023, with males accounting for the majority of procedures.

• Males accounted for 70.47% of all procedures.
• CEA comprised 78.86% of all interventions.
• CAS accounted for 21.14% of all interventions.
• Data were sourced from Australian Institute of Health and Welfare Procedures Data Cubes.

The population-adjusted incidence of CEA declined significantly over the 15-year study period.

• CEA declined by 0.346 procedures per 100,000 people annually (p < 0.001).
• The decline was consistent across all age groups and genders.
• Simple linear regression analysis was used to assess changes in procedure rates over time.
• Population-adjusted incidence rates were calculated using data from the Australian Bureau of Statistics.

The population-adjusted incidence of CAS increased modestly but significantly over the study period.

• CAS incidence increased by 0.061 procedures per 100,000 people annually (p = 0.044).
• The most significant rise in CAS was observed in patients aged 60-69 years.
• The increase in CAS was modest compared to the decline in CEA.

Overall carotid revascularisation procedures declined markedly in Australia over the 15-year study period.

• The decline in overall revascularisation was primarily driven by the significant decline in CEA over time.
• These findings align with global trends.
• The trends reflect the impact of improved medical management and shifting clinical guidelines.
• The growing role of minimally invasive techniques was identified as a contributing factor.