Transcarotid Artery Revascularization Results in Low Rates of Periprocedural Neurologic Events, Myocardial Infarction, and Death

Curr Cardiol Rep. 2020 Jan 15;22(1):3. doi: 10.1007/s11886-020-1256-z.

Abstract

Purpose of review: Transcarotid artery revascularization (TCAR) is a novel hybrid procedure that reverses carotid flow and places a stent using surgical access of the carotid artery in the neck under local anesthesia. We discuss the indications for carotid revascularization, the clinical rationale for TCAR, and evidence for its potential role in the management of carotid stenosis.

Recent findings: Results from pre-clinical studies, prospective single-arm studies, and comparative analyses of registry data indicate that TCAR results in low amounts of periprocedural microembolization, cerebral lesions detectable on magnetic resonance imaging, and neurologic events, myocardial infarctions (MIs), and death. Non-randomized comparisons suggest that TCAR may offer a novel solution to reducing periprocedural stroke, death, and MI in patients with carotid stenosis. A state of equipoise appears to have been reached with TCAR versus the traditional carotid revascularization procedures and a well-controlled randomized trial with careful oversight should be prioritized to obtain level 1 evidence.

Keywords: Carotid artery; Flow reversal; Revascularization; Transcarotid.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Carotid Stenosis / complications
  • Carotid Stenosis / mortality
  • Carotid Stenosis / surgery*
  • Endovascular Procedures / methods*
  • Humans
  • Myocardial Infarction / mortality
  • Postoperative Complications / mortality
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Stents*
  • Stroke / etiology*
  • Time Factors
  • Treatment Outcome
  • Vascular Surgical Procedures / methods*