Carle Heart and Vascular Institute Transcarotid Artery Revascularization Experience
Brian R. Beeman, MD, FACS, FSVS, RPVI.
Clinical Assistant Professor Carle Illinois College of Medicine (CI MED)
Carle Heart and Vascular Institute, Champaign/Urbana, IL
OBJECTIVES:
Transcarotid artery revascularization (TCAR) with dynamic flow reversal is a novel technique used to treat carotid artery stenosis in patients who meet the CMS definition of high surgical risk for carotid endarterectomy (CEA). Although the ROADSTER clinical trial reported the lowest stroke rate compared with any previous trial of carotid artery stenting (CAS), the selection criteria excluded many patients from enrollment since it was highly selective of operators performing the procedures. This limits generalizability to high volume practicing vascular surgeons at busy regional hospitals. Carle Heart and Vascular Institute (HVI) serves as a safety net for over 1.3 million patients at a 413 bed hospital in central Illinois. The goal of this study was to compare the Carle HVI TCAR outcomes to the previous publications of TCAR and or CEA. Our hypothesis is that our results will mirror those of prior carotid revascularization trials.
METHODS:
This is a retrospective cohort study of prospectively collected Vascular Quality Initiative (VQI) data and EMR / EPIC data from 28 patients who underwent TCAR using the ENROUTE neuroprotection and stent system at the Carle Heart and Vascular Institute.
RESULTS:
Between November of 2017 and February 2019, 28 patients underwent TCAR with dynamic flow reversal at the Carle Heart and Vascular Institute by 6 vascular surgeons. 18% of patients were symptomatic and 82% were asymptomatic. Acute device and technical success was 100% (28/28). The all stroke rate was 0%, stroke and death 0%, and stroke, death, and MI was 0%. No patient experienced cranial nerve injury.
CONCLUSIONS:
TCAR with dynamic flow reversal can be performed with high quality outcomes in real-world practice at regional medical centers by vascular surgeons who have a mature experience with both CEA and CAS. Participation in the VQI registry is also a prerequisite. Although only a small retrospective study, our practice revealed a lower peri-operative stroke rate than prior carotid revascularization trials (PROOF, ROADSTER, VQI-TSP, VQI-CEA, CREST-SSR, and SVS-HSR).
Back to 2019 ePosters