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Outcomes Of Transcarotid Artery Revascularization (tcar) In A Rural Community Setting: A Single-institution Review
Rebekah Bjorklund, MD
1, Lutfi Barghuthi, MD
1, Mya Phelps, BS
1, Sarah Stokke, BS
1, Rebecca Swindall, MS
1, Mark Robbins, MD
1, Maham Rahimi, MD
2.
1University of Texas Health Science Center-Tyler, Tyler, TX, USA,
2Houston Methodist, Houstin, TX, USA.
OBJECTIVES: Transcarotid artery revascularization (TCAR) has emerged as a vital alternative to traditional carotid endarterectomy (CEA) for treating carotid artery stenosis. Numerous studies have validated TCAR's efficacy, with outcomes comparable to CEA. This study aims to evaluate the safety and effectiveness of TCAR in a large, single-institution rural setting, highlighting its feasibility and benefits in rural communities with limited healthcare resources.
METHODS: We conducted a retrospective review of 403 patients who underwent TCAR between 2021 and 2024 in a rural East Texas institution. Patients were categorized into symptomatic (n = 195) and asymptomatic (n = 208) groups. All procedures were performed by three board-certified vascular surgeons. We analyzed demographic data, procedural metrics, and 30-day postoperative outcomes, including stroke, myocardial infarction, and mortality. The analysis was conducted to determine significant differences between symptomatic and asymptomatic groups, particularly focusing on key outcome measures relevant to rural settings.
RESULTS: The cohort's mean age was 72 years (SD ± 8), with a male prevalence of 57.7% in the symptomatic group and 51.4% in the asymptomatic group. Symptomatic patients had significantly longer median procedure times (58 minutes) compared to asymptomatic patients (50 minutes, p = 0.009), as well as longer flow-reversal times (6.5 minutes vs. 3 minutes, p = 0.04). The rates of major complications, including myocardial infarction (MI) and stroke, were low across both groups. Within 30 days, stroke rates were higher in the symptomatic group (6.8% vs. 3.9%), though MI rates remained low (0.5% symptomatic, 0% asymptomatic). After 30 days, stroke incidence was significantly higher in symptomatic patients (11.3% vs. 3.4%, p = 0.002), although mortality rates were similar between the groups.
CONCLUSIONS: This study highlights the viability and safety of TCAR as a minimally invasive treatment option for carotid artery stenosis, even in rural settings with constrained healthcare resources. The outcomes are favorable in both symptomatic and asymptomatic patients, suggesting that TCAR is not only a viable alternative to CEA in high-volume centers but also in rural communities, where access to advanced vascular care may be limited. Importantly, these findings advocate for broader adoption of TCAR in rural populations, offering a less invasive option with outcomes comparable to CEA. Further studies in similar rural settings are warranted to refine patient selection and procedural protocols.
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