Department of Vascular Surgery, University of Maryland, 22 South Greene Street, S10-B00, Baltimore, MD, 21201, USA.
Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
Curr Cardiol Rep. 2020 Jan 15;22(1):3. doi: 10.1007/s11886-020-1256-z.
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.
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.
经颈动脉动脉血运重建术（TCAR）是一种新颖的混合手术，通过局部麻醉下的颈部颈动脉手术入路逆转颈动脉血流并放置支架。我们讨论了颈动脉血运重建的适应证、TCAR 的临床原理，以及其在颈动脉狭窄管理中潜在作用的证据。
来自临床前研究、前瞻性单臂研究和注册数据分析的比较结果表明，TCAR 导致的围手术期微栓塞、磁共振成像上可检测到的脑损伤以及神经事件、心肌梗死（MI）和死亡的发生率较低。非随机比较表明，TCAR 可能为减少颈动脉狭窄患者围手术期卒中、死亡和 MI 提供一种新的解决方案。TCAR 与传统颈动脉血运重建术的平衡状态似乎已经达到，应优先进行精心监督的、良好对照的随机试验，以获得一级证据。
