Perioperative And One-year Transcarotid Revascularization Outcomes By Symptom Status
S. Keisin Wang, MD, Sarah Severance, MD, Greg G. Westin, MD, John G. Maijub, MD, Alok K. Gupta, MD, Alan S. Sawchuk, MD, Andres C. Fajardo, MD, Raghu L. Motaganahalli, MD.
Indiana University School of Medicine, Indianapolis, IN, USA.
Objective Reported results of carotid revascularization with both transfemoral stenting (TFCAS) and endarterectomy (CEA) have demonstrated inferior outcomes in neurologically symptomatic patients. This study was completed to determine the real-world, symptom-based outcomes for transcarotid artery revascularization (TCAR).
Methods A retrospective review of all TCARs performed outside of clinical trial regulations from 2015-2019 at our institution was completed. Eligible patients were categorized as symptomatic or not based on a history of a unilateral neurologic deficit attributable to a hemodynamically significant carotid lesion within the previous 180 days. Univariate analysis consisting of Fisherís exact and Studentís T-tests, as appropriate, were performed between cohorts. Kaplan-Meier analysis was completed with respect to stroke-free survival at one-year postoperatively.
Results Within investigation period, 167 patients (85 symptomatic) qualified for study inclusion. Baseline demographics were roughly equivalent although symptomatics were more likely to be female (28.0% vs 9.4%, p<0.01). Procedures in symptomatics were more difficult as measured by a composite of estimated blood loss (41 mLs vs 58 mLs, p=0.04), operative time (67 mins vs 75 mins, p=0.06), and need for conversion to an open technique. We did not observe an increased incidence of macroscopic debris in the ENROUTE (Silk Road, Sunnyvale, CA) neuroprotection filter in symptomatic patients after stent deployment.
Within the 30-day perioperative period, we found no difference with respect to ipsilateral stroke (2.4% vs 1.2%, p>0.99), myocardial infarction (0% vs 0%, p>0.99), and death (0% vs 4.9%, p=0.06). In-hospital mortality in symptomatic patients was 1.2%. During a follow-up period of 16.2 months and 13.3 months, respectively, for asymptomatics and symptomatics, we observed no difference with respect to reintervention, ipsilateral stroke, in-stent stenosis, thrombosis, or all-cause mortality. Lastly, no difference was noted with respect to one-year stroke-free survival.
Conclusion We report a trend towards inferior perioperative results in symptomatic patients receiving TCAR, but no statistically significant results were observed with respect to symptom status in the periprocedural or follow-up phases.
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