Outcomes of Transcarotid Artery Revascularization and Carotid Endarterectomy at a Single Institution
| Autor: | Kathleen M. Lamb, Renganaden Sooppan, Christopher A. Cappellini, Hong Zheng, James Coffey, Robert Q. Luo |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Databases Factual medicine.medical_treatment Arteriovenous fistula Carotid endarterectomy 030204 cardiovascular system & hematology Revascularization Risk Assessment 030218 nuclear medicine & medical imaging 03 medical and health sciences Pseudoaneurysm 0302 clinical medicine Risk Factors Carotid artery disease medicine Humans Carotid Stenosis cardiovascular diseases Stroke Aged Retrospective Studies Aged 80 and over Philadelphia Embolic Stroke Endarterectomy Carotid business.industry Endovascular Procedures General Medicine Perioperative Middle Aged medicine.disease Surgery Stenosis Treatment Outcome Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Annals of Vascular Surgery. 73:329-335 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2020.10.023 |
| Popis: | Background Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are accepted revascularization modalities to treat carotid artery stenosis. Higher incidences of perioperative adverse neurological events and death have been reported in patients with transfemoral CAS. Transcarotid artery revascularization (TCAR) is a newer operative technique that involves direct transcervical carotid access, mitigating aortic arch manipulation and minimizing the risk of embolic stroke via cerebral blood flow reversal. Perioperative stroke, myocardial infarction (MI), and death rates have been shown to be similar between TCAR and CEA, with TCAR having fewer complications. The objective of this study was to ascertain the safety and viability of TCAR by evaluating perioperative outcomes. We hypothesized that patients undergoing TCAR and CEA have equivalent outcomes. Methods We performed a single-institution retrospective review of a prospectively maintained Vascular Quality Initiative database on patients who underwent TCAR or CEA between 2012 and 2019. A total of 66 TCAR cases from February 2018 to December 2019 and 501 CEA cases from January 2012 to December 2019 were reviewed. Preoperative, intraoperative, and postoperative characteristics as well as perioperative outcomes were captured for the statistical analyses. Results From 2012 to 2019, 567 patients underwent TCAR or CEA. Patients who underwent TCAR were found to have higher rates of comorbidities compared with CEA. There were no procedure-related strokes in patients who underwent TCAR. There was no statistically significant difference between TCAR and CEA procedure-related strokes (0% vs. 1.0%, P = 0.42). There were 5 CEA procedure-related strokes because of technical problems resulting in thrombosis of the target vessels. Three patients who underwent CEA had strokes unrelated to the operations. Overall, there were no perioperative deaths, MI, cranial nerve injury (CNI), or hematoma in patients who underwent TCAR. There were no complications of surgical site infection, pseudoaneurysm, or arteriovenous fistula among patients who underwent TCAR or CEA. Conclusions This single-center retrospective analysis of TCAR and CEA for the treatment of carotid artery disease suggests TCAR can result in equivalent perioperative procedure-related stroke as CEA as well as equivalent incidence of perioperative complications including MI, CNI, hematoma, and death in selected patients or patients with proper anatomy. TCAR may be considered a safe, feasible carotid revascularization option for carotid artery stenosis. |
| Databáze: | OpenAIRE |
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