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Risk Factors and Consequences of Bleeding Complications after Transcarotid Artery Revascularization in the Vascular

Christina L Cui1, Laura B Pride1, Lauren N West-Livingston1

  • 1Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.

Annals of Vascular Surgery
|July 11, 2025
PubMed

Insights

Postoperative bleeding after transcarotid artery revascularization (TCAR) is rare but linked to worse outcomes. Intraoperative protamine use significantly reduces bleeding risk, while anticoagulants do not impact complication rates.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Neurosurgery

Background:

  • Previous studies on TCAR bleeding complications were limited to case series.
  • A national-level evaluation of risk factors and consequences of TCAR bleeding is needed.

Purpose of the Study:

  • To identify risk factors for postoperative bleeding complications after TCAR.
  • To determine the consequences of bleeding complications following TCAR.

Main Methods:

  • Retrospective analysis of the Vascular Quality Initiative database (2017-2023).
  • Inclusion of 50,909 TCAR procedures.
  • Logistic regression analysis to identify risk factors for bleeding complications (neck hematomas, surgical bleeding, pseudoaneurysms).

Main Results:

  • Overall bleeding complication rate was 1.9%.
  • Key risk factors included lack of intraoperative protamine, prior carotid endarterectomy, neck radiation, and symptomatic stenosis.
  • Bleeding complications correlated with longer hospitalizations, increased reoperations, and higher rates of nonbleeding complications.

Conclusions:

  • Postoperative bleeding after TCAR is uncommon but associated with adverse systemic and neurologic outcomes.
  • Anticoagulant and antiplatelet regimens were not linked to bleeding risk.
  • Intraoperative protamine administration is associated with a reduced risk of surgical bleeding complications.
Abstract

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