Carotid Interventions in the Community are Associated with Higher Rates of Complications

The Maintaining Internal Systems and Strengthening Integrated Outside Networks Act was a landmark legislation that expanded Veterans' ability to seek care in the community (CITC). The purpose of this study is to evaluate perioperative outcomes among Veterans receiving CITC for carotid artery stenosis (CAS).

This is a retrospective cohort study comparing carotid endarterectomy (CEA) and transcarotid revascularization (TCAR) outcomes for Veterans undergoing interventions through CITC versus at the Durham Veterans Affairs Medical Center (DVAMC). The Corporate Data Warehouse was queried for all patients within our Mid-Atlantic Veterans integrated service network for CITC consults for CAS related International Classification of Diseases-10 codes between November 2022 and November 2023. The retrospective chart review was completed for these patients and for all patients undergoing carotid procedures at the DVAMC during the study period.

A total of 34 CITC consults for 28 patients were placed for carotid related International Classification of Diseases-10 diagnoses. Of these, 10 patients underwent surgical intervention in the community. These included 7 CEAs, 2 TCARs, and 1 stent explant. Of the patients who underwent TCARs, 1 had a postoperative hematoma requiring a take back. Of the patients who underwent CEAs, 1 experienced a cranial nerve injury, 1 experienced a hematoma requiring reoperation, and 1 experienced an infection requiring reoperation. During this same study period, a total of 37 patients underwent 25 CEAs and 12 TCARs at the DVAMC. One patient experienced a transient ischemic attack, another patient experienced a postoperative myocardial infarction and a third experienced a cranial nerve injury that had mostly resolved at his 30-day follow-up. No patient required a reoperation (Fischer exact test P = 0.007 when compared to the CITC cohort).

Although CITC offers a convenient option for surgical care, reoperative rates are significantly higher when compared to outcomes at our local VA hospital. Further efforts are needed to optimize CAS management for Veterans interested in CITC.