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Thirty-Day Perioperative Clinical Outcomes of Transcarotid Artery Revascularization vs Carotid Endarterectomy in a
Ali F AbuRahma1, Adrian Santini1, Zachary T AbuRahma1
1From the Department of Surgery, West Virginia University, Charleston, WV (AF AbuRahma, Santini, ZT AbuRahma, Lee, Seal, Veith).
Insights
Transcarotid artery revascularization (TCAR) and carotid endarterectomy (CEA) show similar 30-day perioperative outcomes in patients undergoing carotid revascularization. This comparative study highlights TCAR as a viable option with comparable safety to CEA.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurosurgery
Background:
- Transcarotid artery revascularization (TCAR) is an emerging alternative to traditional carotid endarterectomy (CEA) and transfemoral stenting, particularly for high-risk patients.
- Recent policy changes have expanded TCAR coverage to standard-risk patients, increasing its clinical relevance.
- Limited single-center data exists comparing TCAR directly with CEA, necessitating further clinical outcome analysis.
Purpose of the Study:
- To compare the 30-day perioperative clinical outcomes between Transcarotid artery revascularization (TCAR) and Carotid endarterectomy (CEA).
- To evaluate the safety and efficacy of TCAR against CEA in a real-world clinical setting.
- To provide data for informed decision-making regarding carotid revascularization techniques.
Main Methods:
- Retrospective analysis of prospectively collected data from the TCAR Surveillance Project.
- Comparison of 30-day perioperative outcomes between TCAR and Carotid endarterectomy (CEA) performed by the same providers.
- Propensity score matching was employed to minimize bias and ensure comparable patient cohorts for outcome analysis.
Main Results:
- The study included 501 patients (347 CEA, 154 TCAR), with no significant difference in symptomatic status between groups.
- Post-propensity matching of 154 patients in each group, both TCAR and CEA demonstrated comparable 30-day perioperative complication rates.
- Specific outcomes such as stroke, death, myocardial infarction, and cranial nerve injury were statistically similar between the TCAR and CEA groups after matching.
Conclusions:
- Propensity match analysis indicates that Transcarotid artery revascularization (TCAR) and Carotid endarterectomy (CEA) offer similar 30-day perioperative outcomes.
- TCAR presents a safe and effective alternative to CEA, with comparable short-term results.
- Further research focusing on long-term clinical outcomes is warranted to fully elucidate the benefits of TCAR versus CEA.
Background:
Transcarotid artery revascularization (TCAR) has been proposed as a alternative to carotid endarterectomy (CEA) and transfemoral carotid artery stenting in high-risk patients. Recently Centers for Medicare and Medicaid Services expanded coverage for TCAR to include standard surgical risk patients within the Society of Vascular Surgery Vascular Quality Initiative TCAR Surveillance Project. Few single centers compared the clinical outcome of TCAR with CEA. This study compares 30-day perioperative clinical outcomes between TCAR and CEA.
Study Design:
This is retrospective analysis of prospectively collected data from the TCAR Surveillance Project of TCAR patients enrolled in our institution and compared with CEAs done in the same time/with the same providers. The primary outcome was stroke and/or death. Secondary outcomes included stroke, death, MI, cranial nerve injury, bleeding, and others. Propensity matching was done to analyze outcomes.
Results:
The study analyzed 501 patients (347 CEA, 154 TCAR). There were no significant differences in symptomatic status (43% for CEA vs 38% for TCAR, p = 0.303). TCAR had more patients with hypertension (p = 0.04), coronary artery disease (p = 0.028), and congestive heart failure (p = 0.039). The 30-day perioperative complication rates for CEA vs TCAR were as follows: stroke 1% vs 3% (p = 0.142), stroke/death 1% vs 3% (p = 0.185), MI 0.6% vs 0.7% (p = 1), death 0.6% vs 0% (p = 1), stroke/death/MI 2% vs 4% (p = 0.233), cranial nerve injury 4% vs 2% (p = 0.412), and major hematoma (requiring reintervention) 2% vs 3% (p = 1). After matching 154 CEA patients and 154 TCAR, 30-day perioperative complication rates were as follows: stroke 2% vs 3% (p = 0.723), stroke/death 3% vs 3% (p = 1), death 1.3% vs 0% (p = 0.498), MI 0.7% vs 0.7% (p = 1), and stroke/death/MI 3% vs 4% (p = 0.759).
Conclusions:
This study showed that using propensity match analysis, both CEA and TCAR have similar 30-day perioperative outcomes. Further long-term data are needed.
