Transcarotid revascularization in obese patients

Area of Science:

• Vascular Surgery
• Minimally Invasive Procedures
• Patient Outcomes

Background:

• Transcarotid revascularization (TCAR) is a hybrid surgical carotid stenting technique using cerebral flow reversal for embolic protection.
• Obesity is a growing concern in surgical patient populations, necessitating risk assessment for various procedures.

Purpose of the Study:

• To evaluate the perioperative risks and outcomes of TCAR specifically in obese patients.
• To compare the safety and efficacy of TCAR in obese versus non-obese patient cohorts.

Main Methods:

• Retrospective review of TCAR procedures from 2015-2022 across two high-volume health systems.
• Obesity defined as a body mass index (BMI) of 35 kg/m² or higher.
• Comparison of demographics, intraoperative, perioperative, and follow-up data between obese and non-obese groups using univariate analysis.

Main Results:

• Of 793 TCAR procedures, 129 patients met the obesity criteria.
• Obese patients had higher rates of hypertension, hyperlipidemia, and diabetes but comparable baseline comorbidities.
• No significant differences were observed in operative time, fluoroscopic time, blood loss, or 30-day perioperative stroke/death rates between groups.
• One-year follow-up showed similar rates of ipsilateral stroke, contralateral stroke, and death in both obese and non-obese cohorts.

Conclusions:

• TCAR in obese patients is not associated with increased intraoperative challenges.
• The incidence of adverse events in the perioperative phase is not statistically higher in obese patients undergoing TCAR.
• TCAR appears to be a safe and effective option for carotid revascularization in the obese population.