Institutional Experiences with Transfemoral Compared to Transcarotid Stenting

Olvera, Alejandro; Leckie, Katherin; Tanaka, Akiko; Motaganahalli, Raghu L.; Madison, Mackenzie; Keyhani, Arash; Keyhani, Kourosh; Wang, S. Keisin

doi:10.1016/j.avsg.2022.04.020

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…We previously reported our institutional results with this emerging technology. 8,[18][19][20][21] At present, there are no randomized controlled trials comparing the two modalities-and we are not likely to get one, due to the costs associated with studying carotid interventions, as the enrollment numbers would be astronomical to adequately power an analysis.…”

Section: Discussionmentioning

confidence: 99%

Fate of Hemodialysis Patients Undergoing Transcarotid Revascularization

Martin

Leckie

Dakour-Aridi

et al. 2022

Vasc Endovascular Surg

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Introduction Carotid revascularization in patients with end-stage renal disease (ESRD) continues to be a controversial topic, as life expectancy is poor, thus, preventing the recouperation of cumulative stroke-risk reduction in the postoperative period. We performed this primarily descriptive analysis of the results of transcarotid revascularization (TCAR) in renal failure patients. Methods A retrospective review of two independent carotid revascularization databases maintained at two large health systems were performed to capture all consecutive TCAR procedures. Patients were classified as either (1) ESRD or (2) preserved renal function (PRF) and compared with standard univariate techniques, where appropriate. Results From December 2015 to April 2022, 851 consecutive TCARs were attempted at our participating facilities. Of these, 27 were performed in ESRD patients (all hemodialysis). These patients were younger and presented with a higher Charlson Comorbidity Index. The incidence of a high anatomic risk criterion as defined for the Centers for Medicare and Medicaid Services (CMS) were similar between groups, as was the incidence of a symptomatic carotid lesion. There were no differences between the groups in terms of intraoperative characteristics and the postoperative medication management were grossly similar by renal function. In the 30-day perioperative period, there were no stroke, death, or myocardial infarction in the 27 ESRD patients treated with TCAR. The mean duration of follow-up in the ESRD cohort was 15.0 months. During this time, there was no ipsilateral stroke events, one contralateral stroke, and one MI. All 27 carotid stents remained patent during this period. Six patients perished after TCAR at a mean interval of 12.2 months after TCAR. Conclusion Survival is poor after carotid revascularization via the TCAR technique on intermediate follow-up. Careful patient selection is required to identify those who will survive to collect on the cumulative stroke-risk reduction afforded by carotid intervention.

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