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Transcervical Versus Transfemoral Approach in Carotid Stenting Real World Experience in a Community Hospital
Deborah Toby1, Sergei Wassiljev1, Lina Kirchner1
1Department of Vascular and Endovascular Therapy, Augusta Hospital and Catholic Hospital Group, Düsseldorf, Germany.
Insights
This study found no significant difference in stroke risk between transcervical and transfemoral carotid artery stenting. Symptomatic lesions, not access type, were linked to in-hospital stroke.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Peri-procedural embolic events are a major complication of carotid stenting.
- Transcervical access was developed to mitigate these risks.
- This study details the experience with transcervical access in a community hospital setting.
Purpose of the Study:
- To compare the safety and efficacy of transcervical versus transfemoral carotid artery stenting.
- To evaluate the incidence of in-hospital stroke associated with each approach.
Main Methods:
- Retrospective analysis of 340 carotid stent procedures (Jan 2010-Dec 2020).
- Comparison of transcervical (156 procedures) and transfemoral (184 procedures) access.
- In-hospital stroke was the primary outcome measure; various stent designs were used.
Main Results:
- 12 patients (3.5%) experienced in-hospital stroke: 4 (2.2%) in the transfemoral group and 8 (5.1%) in the transcervical group (P=0.14).
- Multivariate analysis identified symptomatic lesions as a predictor of in-hospital stroke.
- Neither access type nor stent cell design was significantly associated with increased stroke risk.
Conclusions:
- The study did not confirm the anticipated advantages of the transcervical approach over the transfemoral approach regarding stroke risk.
- Findings should be interpreted cautiously due to the retrospective nature, multiple surgeons, and varied stent types used.
Introduction:
Peri-procedural embolic events are the Achilles' heel of carotid stenting. To overcome this complication, transcervical access to the carotid artery was introduced. In this study we describe our "our life" experience with the transcervical approach in a community hospital.
Material And Methods:
All carotid stent procedures between January 2010 and December 2020 were included in this retrospective analysis. The transcervical approach was compared to the transfemoral approach. In both procedures open-cell, closed-cell design and hybrid stents were used. In-hospital stroke was the primary outcome measure.
Results:
A total of 340 procedures were performed, in 184 patients the transfemoral approach was used and in 156 patients the transcervical approach was used. In 12 patients (3.5%) an in-hospital stroke was diagnosed, 4 in the transfemoral group (2.2%) and 8 in the transcervical group (5.1%) (P = 0.14). In the multivariate analyses a symptomatic lesion was associated with in-hospital stroke. Neither type of access nor cell design was associated with increased risk of in-hospital stroke.
Conclusions:
In contrast to previous studies, we could not confirm the advantages of the transcervical approach. However, conclusions should be carefully drawn, since this study is retrospective and was performed with multiple surgeon and different kind of stents.
