Background
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are accepted revascularization
modalities to treat carotid artery stenosis. Higher incidences of perioperative adverse
neurological events and death have been reported in patients with transfemoral CAS.
Transcarotid artery revascularization (TCAR) is a newer operative technique that involves
direct transcervical carotid access, mitigating aortic arch manipulation and minimizing
the risk of embolic stroke via cerebral blood flow reversal. Perioperative stroke,
myocardial infarction (MI), and death rates have been shown to be similar between
TCAR and CEA, with TCAR having fewer complications. The objective of this study was
to ascertain the safety and viability of TCAR by evaluating perioperative outcomes.
We hypothesized that patients undergoing TCAR and CEA have equivalent outcomes.
Methods
We performed a single-institution retrospective review of a prospectively maintained
Vascular Quality Initiative database on patients who underwent TCAR or CEA between
2012 and 2019. A total of 66 TCAR cases from February 2018 to December 2019 and 501
CEA cases from January 2012 to December 2019 were reviewed. Preoperative, intraoperative,
and postoperative characteristics as well as perioperative outcomes were captured
for the statistical analyses.
Results
From 2012 to 2019, 567 patients underwent TCAR or CEA. Patients who underwent TCAR
were found to have higher rates of comorbidities compared with CEA. There were no
procedure-related strokes in patients who underwent TCAR. There was no statistically
significant difference between TCAR and CEA procedure-related strokes (0% vs. 1.0%,
P = 0.42). There were 5 CEA procedure-related strokes because of technical problems
resulting in thrombosis of the target vessels. Three patients who underwent CEA had
strokes unrelated to the operations. Overall, there were no perioperative deaths,
MI, cranial nerve injury (CNI), or hematoma in patients who underwent TCAR. There
were no complications of surgical site infection, pseudoaneurysm, or arteriovenous
fistula among patients who underwent TCAR or CEA.
Conclusions
This single-center retrospective analysis of TCAR and CEA for the treatment of carotid
artery disease suggests TCAR can result in equivalent perioperative procedure-related
stroke as CEA as well as equivalent incidence of perioperative complications including
MI, CNI, hematoma, and death in selected patients or patients with proper anatomy.
TCAR may be considered a safe, feasible carotid revascularization option for carotid
artery stenosis.
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Article Info
Publication History
Published online: November 25, 2020
Accepted:
October 14,
2020
Received:
July 18,
2020
Footnotes
Declarations of interest: none.
Competing interest statement: All authors have no competing interests to declare.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
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© 2020 Elsevier Inc. All rights reserved.
