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Identifying patients at elevated risk of stroke after transcarotid artery revascularization
Jesse A Columbo1, Pablo Martinez-Camblor2, Caitlin W Hicks3
1Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Vascular Surgery, Heart and Vascular Center, Dartmouth Hitchcock Medical Center, Lebanon, NH; Department of Surgery, Veteran's Health Administration, White River Junction, VT; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH.
Journal of Vascular Surgery
|June 20, 2026
Summary
Transcarotid artery revascularization (TCAR) stroke risk increases with non-compliance to p2y12 inhibitors and multi-stent use. Patients unable to comply with medication or requiring multiple stents may need alternative treatments.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurosurgery
Background:
- Transcarotid artery revascularization (TCAR) is a key treatment for carotid artery disease.
- Factors influencing stroke risk after TCAR require further investigation.
Purpose of the Study:
- Identify patient-specific factors predicting periprocedural stroke after TCAR.
- Characterize risks associated with TCAR in a large patient cohort.
Main Methods:
- Utilized Vascular Quality Initiative data (2016-2024) for 61,111 TCAR patients.
- Employed classification and regression trees (CART) and random forest models.
- Logistic regression adjusted for confounding variables identified by random forest.
Main Results:
- Overall in-hospital stroke rate was 1.33%.
- Key stroke predictors included symptom status, p2y12 inhibitor non-compliance, and multi-stent use.
- Stroke risk increased stepwise: asymptomatic/compliant (0.74%), asymptomatic/non-compliant (1.60%), symptomatic/single stent (1.85%), symptomatic/multi-stent (3.96%).
Conclusions:
- Modifiable factors like p2y12 inhibitor adherence and stent number significantly impact TCAR stroke risk.
- Asymptomatic patients with poor medication compliance or symptomatic patients needing multiple stents may benefit from alternative revascularization strategies.
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