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TCAR Utilization and Access: Comparing Community and Tertiary Hospitals
Marisa Doran, MD1, Carter Colwell, MD
1, Bernard Boateng, MD
1, Lamiere Downing, MD
1, Jane Yang, MD
2, Raju Ashish, MD
1.
1Carilion Clinic - Virginia Tech SOM, Roanoke, VA, USA,
2University of California Los Angeles, Los Angeles, CA, USA.
Objectives- Transcarotid artery revascularization (TCAR) has emerged as a minimally invasive alternative to carotid endarterectomy (CEA) for carotid artery stenosis. Most existing research has been conducted in tertiary care centers and there is limited data on TCAR outcomes and utilization patterns in community hospital settings. This study aims to evaluate evolving trends in procedural utilization for carotid revascularization. It also aims to compare geographic access and safety outcomes between community and tertiary hospitals. Methods- A retrospective review was performed of patients undergoing TCAR and CEA at a community and tertiary hospital between 2018 and 2024. Procedural volumes, patient demographics, anatomic characteristics, geographic distance traveled, and 30-day postoperative outcomes were collected and analyzed. Results- A total of 2,208 patients were included, of which 535 were from a community hospital. TCAR volume increased at the community hospital, surpassing CEA by 2021. There were increasing cases of TCAR at the community hospital with number of TCAR cases surpassing CEA cases in 2021. The ratio of TCAR to CEA was 45:1 at the community hospital in 2024 compared to 1:3 at the tertiary hospital. The number of TCAR cases at the tertiary hospital never surpassed the number of CEA cases. There were no significant differences between TCAR and CEA at either location for distances less than 75 miles. However, the tertiary hospital had 10.84% and 12.72% of TCAR and CEA patients respectively travel over 75 miles and only 3.9% and 6.67% of patients for community TCAR and CEA cases respectively travelled more than 75 miles (p=0.0005). There were no significant differences in postoperative complication rates between the community and tertiary hospital for both TCAR and CEA.
Conclusions- These findings support the safe and effective expansion of TCAR in community hospital settings, with clinical outcomes comparable to tertiary centers. Notably, TCAR utilization surpassed CEA at the community site by 2021 and continued to rise, suggesting a shift in local practice patterns and growing institutional proficiency. The decline in CEA at both sites, particularly at community hospitals, demonstrates evolving procedural preferences. Community-based TCAR may help reduce patient travel burden and promote geographic equity in stroke prevention.
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