Physicians' preference for carotid revascularization impacts postoperative stroke and death outcomes

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Neurosurgery

Background:

• Transcarotid artery revascularization (TCAR) offers a minimally invasive approach for carotid artery stenosis.
• Physician adoption of TCAR varies despite its safety profile.
• Understanding practice patterns is crucial for optimizing carotid revascularization outcomes.

Purpose of the Study:

• To evaluate the impact of physician practice patterns on carotid revascularization outcomes.
• To compare outcomes between physicians performing different combinations of carotid revascularization procedures.
• To identify factors influencing stroke and death rates in carotid interventions.

Main Methods:

• Physicians in the Vascular Quality Initiative (VQI) were categorized based on performing CEA and TCAR, CEA and TFCAS, or all three procedures (CEA, TCAR, TFCAS).
• In-hospital and 1-year outcomes were compared between groups using statistical analyses.
• Exclusion criteria included physicians performing only one procedure type.

Main Results:

• Physicians performing CEA and TFCAS had higher stroke/death rates (2.2%) compared to CEA/TCAR (1.4%) and all three (1.6%).
• TCAR demonstrated comparable outcomes to CEA when performed by the same physicians.
• Transfemoral carotid artery stenting (TFCAS) was associated with inferior outcomes, independent of surgeon experience.

Conclusions:

• Physician procedural preference significantly influences carotid revascularization outcomes.
• TCAR is a safe and effective alternative to CEA, with comparable outcomes.
• Careful patient and procedure selection are paramount for improving carotid revascularization results.