Avoiding Complications with Transcarotid Artery Revascularization

Transcarotid artery revascularization (TCAR) for carotid artery stenting offers an innovative method for treating carotid artery occlusive disease. This technique utilizes the ENROUTE Transcarotid Neuroprotection System (Silk Road Medical, Sunnyvale, CA) to temporarily reverse flow in the carotid artery prior to crossing or treating the carotid lesion, reducing the perioperative risk of stroke. This review aims to summarize possible complications associated with the procedure and offer suggestions to address or avoid these issues in practice.

A review of the available scientific literature was performed via PubMed database queries. Our institutional experience with TCAR was reviewed from a prospectively maintained database. Outcomes assessed included perioperative complications and overall rates of re-stenosis after TCAR.

Potential complications of TCAR were identified and summarized. These are organized based on preoperative, intraoperative, or postoperative timing of the potential complication. Our group's real-world outcomes of 273 patients undergoing TCAR with median (interquartile range) follow up of 17.4 (4.4 -38.7) months, including safety and restenosis data, are presented.

Herein we summarize the available literature regarding potential complications that may be encountered when performing TCAR. Safe and effective clinical outcomes, comparable to those of published clinical trial data, can be successfully achieved in the real-world setting.