Comparative Safety and Efficacy of Transcarotid Artery Revascularization Versus Transfemoral Carotid Artery Stenting:
Atef A Hassan1, Sherif Alaa Sharaby2, Elsayed Elesheshtawy Elbosraty2
1Faculty of Medicine, Al-Azhar University in Cairo, Cairo, Egypt.
Background:
Carotid artery stenosis is a significant cause of ischemic stroke. Transcarotid artery revascularization (TCAR), a newer technique using dynamic flow reversal, has emerged as a potentially safer alternative to transfemoral carotid artery stenting (TFCAS). This systematic review and meta-analysis aimed to compare TCAR and TFCAS in patients undergoing carotid revascularization.
Methods:
We searched PubMed, Cochrane CENTRAL, Scopus, and Web of Science through June 2025 for comparative studies evaluating TCAR versus TFCAS. The primary outcomes included 30-day and in-hospital mortality, stroke, and composite stroke/death. The secondary outcomes assessed myocardial infarction (MI), transient ischemic attack (TIA), procedural times, and periprocedural complications. Risk ratios (RRs) and mean differences were pooled using random-effects models.
Results:
Thirteen studies involving 142,032 patients were included in the analysis. TCAR significantly reduced 30-day mortality (RR 0.45; P < 0.001), in-hospital mortality (RR 0.45; P < 0.001), 30-day stroke (RR 0.66; P < 0.001), and composite 30-day stroke/death (RR 0.57; P < 0.001). TIA (RR 0.72; P < 0.001) and stroke/TIA (RR 0.66; P < 0.001) were also lower with TCAR. MI rates were similar overall, although asymptomatic patients had a higher 30-day MI risk with TCAR. TCAR reduced reperfusion injury (RR 0.38; P < 0.001) and hospital stay length (RR 0.76; P < 0.001) but had slightly longer operative times. Long-term data from 2 large cohorts confirmed TCAR's durable stroke risk reduction up to 3 years.
Conclusion:
This meta-analysis of current observational data demonstrates that TCAR is associated with superior perioperative outcomes compared to TFCAS, with significantly lower rates of stroke and death. These findings support TCAR as a preferred endovascular treatment for eligible patients with carotid artery stenosis.
