Carotid Lesion Length Independently Predicts Stroke And Death After Transcarotid Artery Revascularization And Transfemoral Carotid Artery Stenting
Nadin Elsayed, MD1, Maryam Ali Khan, MD1, Munir Paul Moacdieh, MD1, Ann Gaffey, MD2, Jeffrey Siracuse, MD3, Mahmoud Malas, MD MHS1.
1University of California San Diego, san diego, CA, USA, 2University of Pennsylvania Health System, Philadelphia, PA, USA, 3Boston University School of Medicine, Boston, MA, USA.
OBJECTIVES: Prior data from CREST suggested that the higher perioperative stroke or death event rate among patients treated with transfemoral carotid artery stenting (TFCAS) appears to be strongly related to the lesion length. Nonetheless, data regarding the impact of lesion length on outcomes of transcarotid artery revascularization (TCAR) is lacking. Herein, we aimed to compare the outcomes of TCAR versus TFCAS stratified by the length of carotid lesion.METHODS: Our cohort was derived from the Vascular Quality Initiative database for CAS between 2016 and 2021. Restricted cubic spline analysis was used to describe the relationship between the primary outcome (in-hospital stroke/death) and the exposure variable (lesion length). We therefore divided patients, based on knot with the most significant inflection, into two groups: lesion length<25mm (short) and lesion length ≥25mm. Multivariable logistic regression analysis was used to evaluate in-hospital outcomes stratified by stent approach.RESULTS: The study cohort included 17,931 TCAR (52.6% with long lesions), and 12,036 TFCAS (53.2% with long lesions). Patients with long lesions had higher rates of being symptomatic among both TCAR (27.2% vs 24.3%, P<0.001) and TFCAS (43.5% VS 38.5, p<0.001) patients. After adjusting for potential confounders, long lesions were associated with higher odds of stroke/death, stroke/TIA, and stroke compared to short lesions among patients undergoing TCAR or TFCAS. However, when comparing TCAR vs TFCAS outcomes in patients with long lesions, TCAR was found to be associated with 30-70% reduction in the odds of in-hospital stroke/death (aOR: 0.6, 95%CI (0.5-0.8), P<0.001), mortality (aOR: 0.3, 95%CI (0.2-0.4), P<0.001), stroke (aOR: 0.7, 95%CI (0.5-0.9), P=0.009), stroke/TIA (aOR: 0.7, 95%CI (0.6-0.9), P=0.015), and extended length of stay (ELOS) (aOR: 0.7, 95%CI (0.6-0.8), P<0.001) compared to TFCAS(Table).
CONCLUSIONS: In this retrospective national study, lesion length appears to negatively impact in-hospital outcomes for TCAR and TFCAS. In the presence of long lesion, TCAR appears to be safer than TFCAS with regard to the risk of in-hospital stroke/death, stroke/TIA, and ELOS. These favorable outcomes further confirm superiority of flow reversal compared to distal embolic protection (DEP) devices in terms of neuroprotection since, with TFCAS, it is hazardous passing the DEP through the long lesions.
| TFCAS(Long vs short lesions) | TCAR(Long vs short lesions) | TCAR vs TFCAS (Among patients with long lesions) | ||||
| aOR (95%CI) | P value | aOR (95%CI) | P value | aOR (95%CI) | P value | |
| Stroke/Death | 1.3 (1.05-1.7) | 0.019 | 1.6 (1.3-2.06) | <0.001 | 0.6 (0.5-0.8) | <0.001 |
| Stroke/TIA | 1.3 (1.02-1.7) | 0.033 | 1.5 (1.2-1.9) | 0.001 | 0.7 (0.6-0.9) | 0.015 |
| Stroke | 1.4 (1.01-1.9) | 0.046 | 1.6 (1.2-2.1) | 0.001 | 0.7 (0.5-0.9) | 0.009 |
| Death | 1.2 (0.8-1.6) | 0.334 | 1.5 (0.96-2.3) | 0.074 | 0.3 (0.2-0.4) | <0.001 |
| ELOS | 1.1 (0.97-1.3) | 0.131 | 1.1 (0.97-1.2) | 0.172 | 0.7 (0.6-0.8) | <0.001 |
Back to 2022 ePosters