Intraoperative fusion imaging during transcarotid artery revascularization

Area of Science:

• Medical Imaging
• Vascular Surgery
• Interventional Cardiology

Background:

• Transcarotid artery revascularization (TCAR) is an alternative to traditional carotid interventions.
• TCAR necessitates fluoroscopic guidance, posing radiation risks to patients and surgeons.
• Fusion-guided imaging has shown radiation reduction benefits in other endovascular procedures.

Purpose of the Study:

• To evaluate the outcomes of fusion-guided TCAR (TCAR-F) at a single institution.
• To compare TCAR-F outcomes with regional TCAR cases lacking fusion imaging, using the Vascular Quality Initiative (VQI) registry.

Main Methods:

• Retrospective analysis of TCAR-F cases (n=30) versus VQI TCAR cases (n=2535).
• Primary outcomes: operative time, dose area product, fluoroscopy time, contrast usage, flow-reversal time.
• Statistical comparison using Welch t test and Fisher exact test.

Main Results:

• TCAR-F cases showed significantly lower dose area product (5.67 vs 93.1 Gy cm²), shorter fluoroscopy time (8.07 vs 16.4 min), and less contrast usage (13.49 vs 76.7 mL).
• TCAR-F cases had longer total operative time (117.3 vs 80.9 min) and flow-reversal time (14.4 vs 11.7 min).

Conclusions:

• Fusion-guided TCAR (TCAR-F) demonstrates reduced radiation and contrast agent utilization compared to TCAR without fusion imaging.
• TCAR-F may offer significant radiation protection benefits for both patients and surgical teams.
• Further investigation into TCAR-F's impact on patient outcomes and procedural efficiency is warranted.