Related Experiment Video

Updated: May 3, 2026

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
09:36

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

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Outcomes of Carotid Endarterectomy versus Transcarotid Artery Revascularization in Patients with Significant Cardiac

Aidin Baghbani1, Harleen K Sandhu1, Akiko Tanaka1

  • 1Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, TX.

Annals of Vascular Surgery
|May 1, 2026
PubMed

Insights

Transcarotid artery revascularization (TCAR) and carotid endarterectomy (CEA) are safe options for high-risk cardiac patients undergoing carotid revascularization. Both procedures demonstrate comparable long-term survival and stroke-free outcomes in this population.

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Interventional Cardiology

Background:

  • Patients with reduced left ventricular ejection fraction (LVEF) <30% or persistent arrhythmia face elevated risks during carotid revascularization.
  • Carotid endarterectomy (CEA) is standard, but transcarotid artery revascularization (TCAR) offers a less invasive alternative.
  • Comparative outcomes of CEA versus TCAR in high-risk cardiac patients are not well-defined.

Purpose of the Study:

  • To compare perioperative and long-term outcomes of CEA and TCAR in patients with severe cardiac comorbidities.
  • To evaluate the safety and durability of both revascularization methods in a high-risk population.

Main Methods:

  • Retrospective review of a prospectively maintained database of CEA and TCAR procedures (December 2015 - August 2025).
  • High cardiac risk defined as LVEF <30% and/or persistent arrhythmia.
  • Comparison of baseline demographics, perioperative variables, and outcomes using stratified and survival analyses.

Main Results:

  • 405 of 2,466 patients (16.4%) met high-risk criteria (200 CEA, 205 TCAR).
  • High-risk patients were older and had higher rates of coronary artery disease and anticoagulant use.
  • No significant differences in perioperative stroke, myocardial infarction, or 30-day mortality between CEA and TCAR in high-risk patients. Long-term survival and stroke-free outcomes were also comparable.

Conclusions:

  • CEA and TCAR provide similar perioperative and long-term results for patients with severe cardiac comorbidities.
  • Both procedures are safe and durable options for carotid revascularization in this high-risk group.
Abstract

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