Annals of vascular surgery · 2025
Perioperative and Follow-Up TCAR Outcomes of a Single Institution.
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Dodwad Shah-Jahan M, Dakour-Aridi Hanaa, Martin Gordon H, Saqib Naveed U, Tanaka Akiko, Keyhani Arash, Keyhani Kourosh, Wang S Keisin
Аннотация
BACKGROUND: Transcarotid artery revascularization (TCAR) was developed to mitigate risks associated with both carotid endarterectomy and transfemoral carotid artery stenting. It is being performed in both high- and standard-risk patients. We report outcomes from the largest single-institution consecutive TCAR cohort to date.
METHODS: A retrospective review was performed from a prospectively maintained database capturing all consecutive TCAR procedures performed across a large health system between September 2017 and May 2025. Demographics, perioperative variables, and short- and long-term outcomes were analyzed. A multivariable logistic regression was used to identify predictors of perioperative stroke or death within 30 days.
RESULTS: A total of 1,000 TCAR procedures were performed by 23 surgeons. The mean age was 74 years. In all, 31% of patients presented with symptomatic stenosis. Technical success was achieved in 98%. Thirty-day stroke, death, and myocardial infarction occurred at 1.9%, 1.0%, and 0.2%, respectively, for a composite rate of 2.9%. The median length of stay was 1 day. At a mean follow-up of 18 months, ipsilateral stroke occurred in 3.4%, restenosis/reintervention in 1.7%, and all-cause mortality in 6.6%. Multivariable analysis identified prior stroke (odds ratio [OR] 2.4, P < 0.001) and chronic obstructive pulmonary disease (OR 1.7, P = 0.011) as independent predictors of perioperative stroke/death. Protective factors included clopidogrel use (OR 0.45, P = 0.014) and intraoperative administration of protamine (OR 0.47, P = 0.011).
CONCLUSION: TCAR demonstrated high technical success, low perioperative morbidity, and favorable long-term outcomes in both high- and standard-risk patients. Optimal medical management and risk stratification by comorbidity and prior neurologic events improve outcomes. Randomized trials are needed to better define the roles of TCAR and carotid endarterectomy.
METHODS: A retrospective review was performed from a prospectively maintained database capturing all consecutive TCAR procedures performed across a large health system between September 2017 and May 2025. Demographics, perioperative variables, and short- and long-term outcomes were analyzed. A multivariable logistic regression was used to identify predictors of perioperative stroke or death within 30 days.
RESULTS: A total of 1,000 TCAR procedures were performed by 23 surgeons. The mean age was 74 years. In all, 31% of patients presented with symptomatic stenosis. Technical success was achieved in 98%. Thirty-day stroke, death, and myocardial infarction occurred at 1.9%, 1.0%, and 0.2%, respectively, for a composite rate of 2.9%. The median length of stay was 1 day. At a mean follow-up of 18 months, ipsilateral stroke occurred in 3.4%, restenosis/reintervention in 1.7%, and all-cause mortality in 6.6%. Multivariable analysis identified prior stroke (odds ratio [OR] 2.4, P < 0.001) and chronic obstructive pulmonary disease (OR 1.7, P = 0.011) as independent predictors of perioperative stroke/death. Protective factors included clopidogrel use (OR 0.45, P = 0.014) and intraoperative administration of protamine (OR 0.47, P = 0.011).
CONCLUSION: TCAR demonstrated high technical success, low perioperative morbidity, and favorable long-term outcomes in both high- and standard-risk patients. Optimal medical management and risk stratification by comorbidity and prior neurologic events improve outcomes. Randomized trials are needed to better define the roles of TCAR and carotid endarterectomy.