30-Day Perioperative and 1 Year Clinical Outcome of Transcarotid Artery Revascularization in 100 Consecutive Patients: A Single-Center Experience
Ali F. AbuRahma1, Zachary AbuRahma1, Adrian Santini1, Matthew Beasley1, Meghan Davis1, Andrew Lee1, Christina Veith1, Mazen A. Roshdy1, L. Scott Dean2, Elaine Davis2
1West Virginia University-Charleston Division, Charleston, WV;2CAMC Institute for Academic Medicine, Charleston, WV
Background/Purpose: Transcarotid Artery Revascularization (TCAR) using the ENROUTE system (Silk Road) has been proposed as a safe and effective alternative to both carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS). Two large registries (ROADSTER 1 & ROADSTER 2) have shown that TCAR has acceptable/low rates of perioperative stroke/death. This study will analyze the 30-day perioperative and 1 year clinical outcome from a single-center.Patient Population & Method: This is a retrospective analysis of prospectively collected data from SVS/VQI TCAR surveillance project (TSP) of 100 consecutive patients (102 TCAR procedures) done in our institution. These procedures were done for high-risk patients for CEA, which included anatomical (previous CEA, high cervical lesion, neck radiation, stoma, arch type, etc.), physiological (CHF, severe coronary artery disease, COPD on 02 therapy, etc.) and combined anatomical/physiological reasons. These procedures were done by vascular surgeons after receiving the appropriate training. The perioperative stroke, death, and MI were analyzed. Kaplan Meyer analysis was used to estimate rate of freedom from stroke/death and the incidence of ≥50% and ≥80% in-stent restenosis at 1 year. Results: 100 consecutive high-risk patients for CEA included: 38% anatomical, 44% physiological and 18% combined anatomical and physiological reasons. The mean age was 72.5 years (range 52-90 years). Indications for TCAR were 34% for symptomatic lesions (TIA/stroke) and 66% for asymptomatic lesions. Mean ipsilateral treated stenosis was 80.4%. Contralateral ≥50% stenosis/occlusion was present in 31% of patients. Technical success rate was 100%. 92% had pre-stenting PTA and 26% had post-stenting PTA. The mean flow reversal time was 8.5 minutes (range 3-26 minutes). The 30-day perioperative stroke rate was 2.9% (1/67, 1.5% for asymptomatic patients), the stroke/death rate was 2.9%, and stroke/death and MI rates was 3.9% (4/102). Other perioperative complications included: cranial nerve injury 3/102 (2.9%), carotid artery dissection (2%) and major hematoma (necessitated operation evacuation) (5.9%). Freedom from stroke rates and stroke/death rates at 1 year were: 90% and 89%. Regardless, freedom from ≥50% and ≥80% in-stent restenosis rates at 1 year were 82% and 90%, respectively. None of these restenosis were symptomatic except two. Freedom from reintervention rate at 1 year was 98%. Conclusion: Although the perioperative events were somewhat higher than what has been reported in previous registries, TCAR for patients who are high-risk for CEA has a low perioperative stroke and stroke/death rates with satisfactory outcome at 1 year. Further long-term data is probably needed to verify long-term outcome.
Back to 2022 Posters