Treatment of High-Risk Patients with Carotid Artery Stenosis using Transcarotid Artery Revascularization in a single academic center
Patrick Jasinski, MD, Panagiotis Drakos, MD, Georgios Tzavellas, MD, Apostolos Tassiopoulos, MD, Shang Loh, MD, George Koullias, MD, Angela Kokkosis, MD.
Stony Brook Medicine, Stony Brook, NY, USA.
OBJECTIVES: Transcarotid artery revascularization (TCAR) provides a novel approach to treat high-grade carotid artery stenosis in patients with clinical and anatomic risk factors who are poor candidates for carotid endarterectomy (CEA) or transfemoral carotid artery stenting (CAS). The purpose of this study is to demonstrate a single academic center’s experience using the ENROUTE® Transcarotid Neuroprotection System.
METHODS: A retrospective analysis of males and females at a single academic institution was performed. Examined patients were treated using TCAR approach from October 2016 to June 2017. Eligible candidates included patients with high-grade carotid artery stenosis defined as ≥80% stenosis for asymptomatic and ≥60% for symptomatic patients, with clinical and/or anatomic high-risk elements. Examined factors included patient demographics, comorbidities, the VSG-CRI risk factor score, and Wallert life expectancy. Follow-up visits were scheduled within 30 days postoperatively to evaluate for any neurologic deficits as well as stent patency utilizing Duplex ultrasonography (DU). Primary outcomes included patency, stroke, myocardial infarction, death, device failure, and access site complications.
RESULTS: TCAR was performed on 25 patients (17 males and 8 females). High-grade stenosis was identified in 10 patients using Computed Tomography and 15 patients using DU. Mean duplex PSV and EDV were 443.53±186.51 cm/s and 128.35±74.48 cm/s respectively. Study group mean age was 73.7 years (53-86 years) with majority of patients having a BMI >25. Most patients were asymptomatic (21), 1 patients presented with TIA and 3 had ischemic strokes. Significant characteristics in majority of the patients included hypertension (n=21), hyperlipidemia (n=23), history of smoking (n=19), and CAD (n=19). The average VSG-CRI risk score was 6.6 (3-10), denoting a 6-7% risk of adverse cardiac events; and the Wallert life expectancy was medium risk for majority of patients, denoting an 80% 5-year survival. No perioperative complications were encountered and the mean length of stay was 1.12±.44 days. Twenty-four patients presented for their 1-month follow-up. Of those, all patients had patent carotid stents without neurologic deficits, device failure or cardiac event.
CONCLUSIONS: TCAR is an innovative and well-tolerated carotid artery revascularization technique in a cohort of high-risk patients with severe carotid artery stenosis. This treatment modality appears to be a safe alternative to CEA and CAS for patients with clinical and/or anatomic risk factors.
Back to 2018 ePosters
