Cerebral Hyperperfusion Syndrome Risk Comparison between Transcarotid Artery Revascularization and Carotid Artery...

Area of Science:

• Vascular Surgery
• Neurology
• Interventional Cardiology

Background:

• Cerebral hyperperfusion syndrome (CHS) is a serious complication post-carotid revascularization.
• The impact of different carotid artery stenting (CAS) modalities on CHS is not well-defined.

Purpose of the Study:

• To compare the incidence, severity, and outcomes of CHS between transcarotid artery revascularization (TCAR) and CAS with distal embolic protection (CAS+DEP).

Main Methods:

• Retrospective analysis of 69,480 patients from the Vascular Quality Initiative (2016-2023).
• Patients underwent TCAR or CAS+DEP, stratified by symptom status and urgency.
• Primary outcome: CHS occurrence. Secondary outcomes: CHS severity, mortality, and hospitalization length.

Main Results:

• TCAR cohort had lower CHS incidence (0.53% vs. 1.1%, P<0.001).
• TCAR showed a 2-fold lower CHS risk in symptomatic patients (aOR: 0.52, P<0.001).
• TCAR patients with CHS experienced reduced mortality, shorter hospitalization, and less severe CHS.

Conclusions:

• TCAR is associated with a lower risk of CHS than CAS+DEP in symptomatic patients.
• TCAR leads to milder CHS forms and better outcomes, including lower mortality, compared to CAS+DEP.