Fixed compared to mobile imaging arms for transcarotid artery revascularization

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Imaging

Background:

• Transcarotid artery revascularization (TCAR) is an emerging endovascular technique for treating carotid artery stenosis.
• Hybrid operating rooms (OR) are considered optimal for TCAR due to advanced imaging capabilities.
• The feasibility of TCAR in standard ORs using portable C-arm fluoroscopy remains under investigation.

Purpose of the Study:

• To compare intraoperative and perioperative outcomes of TCAR procedures performed in hybrid ORs versus standard ORs with portable C-arm fluoroscopy.
• To evaluate the safety and efficacy of TCAR when utilizing different imaging modalities.
• To determine if advanced intraoperative imaging is essential for successful TCAR outcomes.

Main Methods:

• Retrospective review of 503 TCAR procedures performed between September 2017 and May 2022.
• Patients were divided into two cohorts: hybrid OR (n=422) and standard OR with portable C-arm (n=81).
• Comparison of patient demographics, intraoperative results, and postoperative outcomes using univariate analysis.

Main Results:

• Procedures in hybrid ORs showed increased blood loss and operative time but reduced fluoroscopy time compared to portable C-arm.
• No significant differences were observed in postoperative stroke (2.4% vs. 2.5%), myocardial infarction (0.2% vs. 0%), or death (0.7% vs. 2.5%) between the groups.
• Fluoroscopy time was significantly lower in the hybrid OR group (4.0 ± 2.6 min) compared to the portable C-arm group (5.2 ± 5.8 min).

Conclusions:

• TCAR can be performed safely and effectively in standard ORs using portable C-arm fluoroscopy.
• While intraoperative metrics like blood loss and operative time may vary, postoperative clinical outcomes are comparable.
• The absence of a hybrid OR should not impede the adoption and utilization of TCAR procedures.