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Lessons Learned After 650 Tcars In The Community: A Decade-long Experience From Early Adopters
Matthew Kenny
1, Brittany Landavazo
1, Chandler Vernon
2, Shir Yelovitch, PhD
3, Kofi Quaye, MD
3, David Nation, MD
3, Nicolas Zea, MD
3, Jeff Apple, MD
3, Ryan Turley
3.
1Texas A&M College of Medicine, Round Rock, TX, USA,
2Texas A&M University, College Station, TX, USA,
3Cardiothoracic & Vascular Surgeons, Austin, TX, USA.
Objective: Transcarotid arterial revascularization (TCAR) with flow reversal is a well-established minimally invasive alternative to carotid endarterectomy. Our multicenter, private practice is an early adopter and has performed TCARs in the community since 2013. We report our real-world experience after performing 650 TCARs over ten years in the community.
Methods: 656 TCAR procedures were performed on 589 patients between 2013-2024. A retrospective chart review was performed on these procedures. The cohort included 9 vascular surgeons across 10 hospitals. All procedures used the enroute transcarotid neuroprotection system (NPS), which uses common carotid access and high-rate flow reversal as embolic protection during stenting. The primary endpoints for this study are 30-day rates of stroke and myocardial infarction (MI). Secondary endpoints included operative time, cranial nerve injury, neck hematoma requiring evacuation, arterial dissection, and death.
Results: 656 TCAR procedures were performed on 589 unique patients. 404 (61.85)% of patients were asymptomatic at the time of surgery. The median patient age was 73 (67-79) years. Patient medical history, surgical history, pre- and post-dilation balloon sizes, stent sizes, operative time, flow-reversal time, contrast volume, reoperation status, discharge statin, and anticoagulation therapies are listed in
Table 1. Eleven patients suffered a perioperative stroke (1.68%) within 30 days of the operations, and ten ( 1.52%) suffered a stroke greater than thirty days but within one year of the operation. MI occurred in one patient (0.13%) within 30 days, and six (0.91%) within one year. Cranial nerve injury occurred in 10 (1.52%) patients, defined as either dysphagia (n=1) or hoarseness (n=9). Neck hematoma with evacuation occurred in 10 (1.52%). An arterial dissection transpired in a single patient (0.15%).
Conclusions: Over the last decade, TCAR has emerged as an effective and efficient first-line therapy for treating suitable patients with carotid artery stenosis, regularly in less than 1 hour of operative time. Early adoption and integration of this technology into practice have yielded excellent patient outcomes, matching or surpassing those reported in the literature for the gold standard, CEA.
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