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AbuRahma AF, AbuRahma ZT, Santini A, Beasley M, Davis M, Lee A, Veith C, Roshdy M, Dean LS, Davis E. A single-center experience of 30-day perioperative and one year clinical outcomes of transcarotid artery revascularization in 100 consecutive patients. Vascular 2023; 31:1161-1172. [PMID: 35634873 DOI: 10.1177/17085381221106330] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
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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Affiliation(s)
- Ali F AbuRahma
- Department of Surgery, Charleston Area Medical Center Health System Inc, Charleston, WV, USA
| | - Zachary T AbuRahma
- Department of Surgery, Charleston Area Medical Center Health System Inc, Charleston, WV, USA
| | - Adrian Santini
- Department of Surgery, Charleston Area Medical Center Health System Inc, Charleston, WV, USA
| | - Matthew Beasley
- Department of Surgery, Charleston Area Medical Center Health System Inc, Charleston, WV, USA
| | - Meghan Davis
- Department of Surgery, Charleston Area Medical Center Health System Inc, Charleston, WV, USA
| | - Andrew Lee
- Department of Surgery, Charleston Area Medical Center Health System Inc, Charleston, WV, USA
| | - Christina Veith
- Department of Surgery, Charleston Area Medical Center Health System Inc, Charleston, WV, USA
| | - Mazen Roshdy
- Department of Surgery, Charleston Area Medical Center Health System Inc, Charleston, WV, USA
| | - L Scott Dean
- Department of Surgery, Charleston Area Medical Center Health System Inc, Charleston, WV, USA
| | - Elaine Davis
- Department of Surgery, Charleston Area Medical Center Health System Inc, Charleston, WV, USA
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Lamarca MP, Flores Á, Martín A, Peinado J, Estébanez S, Arriola M, Llergo B, García E, Tique J, Torralbas F, Millán E, Rigolin M, Lobato P, Segundo JC, Morín M, Jamilena Á, Moreno R, Orgaz A. Prospective evaluation of acute cerebral injury by DW-MRI following transcarotid artery revascularization using a double-layer micromesh stent. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:583-590. [PMID: 38078708 DOI: 10.23736/s0021-9509.23.12764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Transcervical carotid artery revascularization (TCAR) has demonstrated a low overall stroke rate in carotid artery stenting (CAS). Furthermore, the use of a double-layer micromesh stent is expected to reduce embolization and plaque prolapse. The combination of TCAR and the double layer stent may lead to improved results compared to previously reported outcomes. The objective of this study is to present the findings of a prospective study including patients treated with the Roadsaver stent and TCAR. METHODS Between January 2017 and May 2022, 85 patients were enrolled. Every patient underwent TCAR with the Roadsaver stent. As per our protocol, a neurological examination and an ultrasound were performed within 24 hours before and after the procedure, and again 30 days after. A diffusion-weighted magnetic resonance imaging (DW-MRI) was conducted 24 hours before the procedure and 48-72 hours after the procedure. The primary endpoint was the detection of new ischemic lesions on postoperative DW-MRI. The secondary endpoint was a composite of all strokes, death, and myocardial infarction within 30 days. RESULTS Sixty-four patients (75.29%) were symptomatic, out of which 25 were treated within 14 days of the onset of the symptoms. Pre and postprocedural DW-MRI were performed in 83 patients. Postprocedural lesions were found in nine patients (10.84%). There were no strokes or death within 30 days, but two patients experienced a myocardial infarction. CONCLUSIONS Our study suggests that the use of TCAR and the Roadsaver stent could be a safe alternative to carotid endarterectomy because it entails a low incidence of cerebral embolization, even in recently symptomatic and elderly patients.
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Affiliation(s)
- María P Lamarca
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain -
| | - Ángel Flores
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Alberto Martín
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Javier Peinado
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Santiago Estébanez
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Maite Arriola
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Belén Llergo
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Enrique García
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Julián Tique
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Fredy Torralbas
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Elisa Millán
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Martina Rigolin
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Paula Lobato
- Stroke Section, Department of Neurology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - José C Segundo
- Stroke Section, Department of Neurology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Mar Morín
- Stroke Section, Department of Neurology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Álvaro Jamilena
- Stroke Section, Department of Neurology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Raquel Moreno
- Neuroradiology Section, Department of Radiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Antonio Orgaz
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
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AbuRahma AF, Santini A, AbuRahma ZT, Lee A, Seal K, Veith C, Dean S, Davis E. Thirty-Day Perioperative Clinical Outcomes of Transcarotid Artery Revascularization vs Carotid Endarterectomy in a Single-Center Experience. J Am Coll Surg 2023; 236:668-674. [PMID: 36728406 DOI: 10.1097/xcs.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Transcarotid artery revascularization (TCAR) has been proposed as a alternative to carotid endarterectomy (CEA) and transfemoral carotid artery stenting in high-risk patients. Recently Centers for Medicare and Medicaid Services expanded coverage for TCAR to include standard surgical risk patients within the Society of Vascular Surgery Vascular Quality Initiative TCAR Surveillance Project. Few single centers compared the clinical outcome of TCAR with CEA. This study compares 30-day perioperative clinical outcomes between TCAR and CEA. STUDY DESIGN This is retrospective analysis of prospectively collected data from the TCAR Surveillance Project of TCAR patients enrolled in our institution and compared with CEAs done in the same time/with the same providers. The primary outcome was stroke and/or death. Secondary outcomes included stroke, death, MI, cranial nerve injury, bleeding, and others. Propensity matching was done to analyze outcomes. RESULTS The study analyzed 501 patients (347 CEA, 154 TCAR). There were no significant differences in symptomatic status (43% for CEA vs 38% for TCAR, p = 0.303). TCAR had more patients with hypertension (p = 0.04), coronary artery disease (p = 0.028), and congestive heart failure (p = 0.039). The 30-day perioperative complication rates for CEA vs TCAR were as follows: stroke 1% vs 3% (p = 0.142), stroke/death 1% vs 3% (p = 0.185), MI 0.6% vs 0.7% (p = 1), death 0.6% vs 0% (p = 1), stroke/death/MI 2% vs 4% (p = 0.233), cranial nerve injury 4% vs 2% (p = 0.412), and major hematoma (requiring reintervention) 2% vs 3% (p = 1). After matching 154 CEA patients and 154 TCAR, 30-day perioperative complication rates were as follows: stroke 2% vs 3% (p = 0.723), stroke/death 3% vs 3% (p = 1), death 1.3% vs 0% (p = 0.498), MI 0.7% vs 0.7% (p = 1), and stroke/death/MI 3% vs 4% (p = 0.759). CONCLUSIONS This study showed that using propensity match analysis, both CEA and TCAR have similar 30-day perioperative outcomes. Further long-term data are needed.
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Affiliation(s)
- Ali F AbuRahma
- From the Department of Surgery, West Virginia University, Charleston, WV (AF AbuRahma, Santini, ZT AbuRahma, Lee, Seal, Veith)
| | - Adrian Santini
- From the Department of Surgery, West Virginia University, Charleston, WV (AF AbuRahma, Santini, ZT AbuRahma, Lee, Seal, Veith)
| | - Zachary T AbuRahma
- From the Department of Surgery, West Virginia University, Charleston, WV (AF AbuRahma, Santini, ZT AbuRahma, Lee, Seal, Veith)
| | - Andrew Lee
- From the Department of Surgery, West Virginia University, Charleston, WV (AF AbuRahma, Santini, ZT AbuRahma, Lee, Seal, Veith)
| | - Kimberly Seal
- From the Department of Surgery, West Virginia University, Charleston, WV (AF AbuRahma, Santini, ZT AbuRahma, Lee, Seal, Veith)
| | - Christina Veith
- From the Department of Surgery, West Virginia University, Charleston, WV (AF AbuRahma, Santini, ZT AbuRahma, Lee, Seal, Veith)
| | - Scott Dean
- the Charleston Area Medical Center Health Education and Research Institute, Charleston, WV (Dean, Davis)
| | - Elaine Davis
- the Charleston Area Medical Center Health Education and Research Institute, Charleston, WV (Dean, Davis)
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Olvera A, Leckie K, Tanaka A, Motaganahalli RL, Madison MK, Keyhani A, Keyhani K, Wang SK. Institutional Experiences with Transfemoral Compared to Transcarotid Stenting. Ann Vasc Surg 2022; 86:366-372. [DOI: 10.1016/j.avsg.2022.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/04/2022] [Accepted: 04/09/2022] [Indexed: 11/01/2022]
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