Poststent ballooning during transcarotid artery revascularization

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Neurology

Background:

• Transfemoral carotid artery stenting (TCS) with post-stent ballooning (post-SB) is associated with increased stroke risk.
• Transcarotid artery revascularization (TCAR) utilizes dynamic cerebral blood flow reversal, prompting investigation into the safety of post-SB during TCAR procedures.

Purpose of the Study:

• To evaluate the impact of post-SB during TCAR on in-hospital stroke or death.
• To assess the association between different angioplasty strategies (pre-SB, post-SB, prepost-SB) and procedural outcomes in TCAR patients.

Main Methods:

• Analysis of 5161 patients undergoing TCAR from September 2016 to May 2019.
• Patients were categorized into three groups: pre-SB only, post-SB only, and both pre-SB and post-SB.
• In-hospital stroke/death was the primary outcome, analyzed using univariable and multivariable logistic regression.

Main Results:

• No significant difference in in-hospital or 30-day stroke/death rates was observed among the three angioplasty groups (pre-SB, post-SB, prepost-SB).
• Patients undergoing post-SB or prepost-SB had significantly higher rates of in-hospital transient ischemic attacks (TIAs) and postprocedural hypotension.
• Multivariable analysis confirmed no association between post-SB and in-hospital stroke/death, but identified a fourfold increased odds of TIA with post-SB or prepost-SB compared to pre-SB alone.

Conclusions:

• Post-SB during TCAR appears safe regarding in-hospital stroke/death.
• The increased incidence of TIAs associated with post-SB warrants further investigation.
• TCAR angioplasty strategies do not significantly impact major stroke or death outcomes but influence TIA rates.