Safety and efficacy of transcarotid artery revascularization in a community hospital

Zebolsky, Aaron L.; Chou, Jesse; Key, Phillip; Knight, Patrick; Mahmood, Gulrez; Jain, Krishna M.; Rummel, Mark

doi:10.1016/j.jvs.2020.12.066

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…12 When evaluating our institutional experience, our 30-day perioperative stroke rate was 2.9%, with a stroke and death rate of 2.9%, and stroke/death/MI rate of 3.9%. These rates were similar to what has been reported by Zebolsky et al, 15 Wang et al, 12 and Yee et al, 21 who reported a 30-day stroke rate of 2.7%, with a stroke and death rate of 2.7%.…”

Section: Discussionsupporting

confidence: 91%

“…Zebolsky et al 15 also reported on the safety and efficacy of TCAR in a community hospital where 147 of 149 attempted TCAR cases were analyzed during a 33-month period. The perioperative and 30-day major adverse event (stroke, death, MI) rates were 0.7% and 3.4%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…These studies were small and most reported 30-day outcomes only. [12][13][14][15] Ghamraoui et al 13 reported the outcome of 97 TCAR procedures in octogenarians and elderly patients, of whom 43 (44%) were patients >80 years of age, with no 30-day perioperative neuro events, MI, cranial nerve injury, or death. Cappellini et al 14 also reported on outcome of TCAR and CEA at a single institution where a total of 66 TCAR cases that were treated between February 2018 and December 2019 and compared the outcome to 501 CEA cases done between January 2012 and December 2019.…”

Section: Discussionmentioning

confidence: 99%

“…7 Since the publications of the industry sponsored ROADSTER 1 and ROADSTER 2 studies, few other studies from the SVS/VQI data were published with somewhat similar results. [8][9][10][11] However, few single-center experiences have been published using the ENROUTE system (Silk Road, Sunnyvale, California) to verify the results of ROADSTER 1 and 2 since launching the SVS/ VQI TCAR Surveillance Project (TSP) in September 2016, [12][13][14][15] and mostly reporting 30-day outcomes only. The purpose of this study is to assess our center's experience and report 30-day and 1-year outcomes with TCAR in comparison to the results from ROADSTER 1 and 2.…”

Section: Introductionmentioning

confidence: 99%

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A single-center experience of 30-day perioperative and one year clinical outcomes of transcarotid artery revascularization in 100 consecutive patients

AbuRahma

Santini

et al. 2022

Vascular

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Background 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 and 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 outcomes from a single-center. Patient population and methods 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 O2 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 rates 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 min (range 3–26 min). 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 rate 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%. 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 (2/13). 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.

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