Letter by Giri Regarding Article, “Comparative Effectiveness of Carotid Revascularization Therapies: Evidence From a National Hospital Discharge Database”

After reading the article by McDonald et al,1 I have several concerns about the analysis and the authors’ interpretations of the results. First, a national registry encompassing carotid revascularization procedures at 141 institutions has demonstrated the folly in using large observational data to compare outcomes of carotid artery stenting (CAS) versus carotid endarterectomy.2 The referral patterns for these 2 procedures are so fundamentally different, with CAS being performed in cohorts with much higher comorbidities, that even well-performed propensity-matched analyses fail to balance groups for confounders. Despite the authors claims that their propensity match …