To compare the outcomes of TransCarotid Artery Revascularization with flow reversal (TCAR) to the gold standard carotid endarterectomy (CEA) using data from the Society for Vascular Surgery Vascular Quality Initiative TCAR Surveillance Project.
Summary Background Data:
TCAR is a novel minimally invasive procedure for carotid revascularization in high-risk patients that is associated with significantly lower stroke rates compared with carotid artery stenting via the transfemoral approach.
Patients in the United States and Canada who underwent TCAR and CEA for carotid artery stenosis (2016- 2019) were included. Propensity scores were calculated based on baseline clinical variables and used to match patients in the two treatment groups (n=6,384 each). The primary endpoint was the combined outcome of perioperative stroke and/or death.
No significant differences were observed between TCAR and CEA in terms of in-hospital stroke/death [TCAR,1·6% vs.CEA,1·6%, RR (95% CI):1·01(0·77–1·33), P=·945], stroke [1·4% vs.1·4%, RR(95%CI):1·02(0·76–1·37), P=·881], or death [0·4% vs.0·3%, RR (95%CI):1·14 (0·64–2·02), P =·662]. Compared to CEA, TCAR was associated with lower rates of in-hospital myocardial infarction [0·5% vs. 0·9%, RR (95%CI):0·53 (0·35–0·83), P =·005], cranial nerve injury [0·4% vs.2·7%, RR(95%CI):0·14(0·08–0·23), P<·001], and post-procedural hypertension [13% vs.18·8%, RR(95% CI):0·69(0·63–0·76), P <·001]. They were also less likely to stay in the hospital for more than one day [26·4% vs.30·1%, RR (95%CI):0·88(0·82–0·94), P<·001]. No significant interaction was observed between procedure and symptomatic status in predicting postoperative outcomes. At one year, the incidence of ipsilateral stroke or death was similar between the two groups [HR (95%CI):1·09(0·87–1·36), P=·44].
This propensity-score matched analysis demonstrated significant reduction in the risk of postoperative myocardial infarction and cranial nerve injury after TCAR compared to CEA, with no differences in the rates of stroke/death.