Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, La Jolla, California.
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Ann Surg. 2022 Aug 1;276(2):398-403. doi: 10.1097/SLA.0000000000004496. Epub 2020 Sep 15.
To compare the outcomes of TCAR with flow reversal to the gold standard CEA using data from the Society for Vascular Surgery Vascular Quality Initiative TCAR Surveillance Project.
TCAR is a novel minimally invasive procedure for carotid revascularization in high-risk patients that is associated with significantly lower stroke rates compared with carotid artery stenting via the transfemoral approach.
Patients in the United States and Canada who underwent TCAR and CEA for carotid artery stenosis (2016-2019) were included. Propensity scores were calculated based on baseline clinical variables and used to match patients in the 2 treatment groups (n = 6384 each). The primary endpoint was the combined outcome of perioperative stroke and/or death.
No significant differences were observed between TCAR and CEA in terms of in-hospital stroke/death [TCAR, 1.6% vs CEA, 1.6%, RR (95% CI): 1.01 (0.77-1.33), P = 0.945], stroke [1.4% vs 1.4%, RR (95% CI): 1.02 (0.76-1.37), P = 0.881], or death [0.4% vs 0.3%, RR (95% CI): 1.14 (0.64-2.02), P = 0.662]. Compared to CEA, TCAR was associated with lower rates of in-hospital myocardial infarction [0.5% vs 0.9%, RR (95% CI): 0.53 (0.35-0.83), P = 0.005], cranial nerve injury [0.4% vs 2.7%, RR (95% CI): 0.14 (0.08-0.23), P < 0.001], and post-procedural hypertension [13% vs 18.8%, RR (95% CI): 0.69 (0.63-0.76), P < 0.001]. They were also less likely to stay in the hospital for more than 1 day [26.4% vs 30.1%, RR (95% CI): 0.88 (0.82-0.94), P < 0.001]. No significant interaction was observed between procedure and symptomatic status in predicting postoperative outcomes. At 1 year, the incidence of ipsilateral stroke or death was similar between the 2 groups [HR (95% CI): 1.09 (0.87-1.36), P = 0.44].
This propensity-score matched analysis demonstrated significant reduction in the risk of postoperative myocardial infarction and cranial nerve injury after TCAR compared to CEA, with no differences in the rates of stroke/death.
利用血管外科学会血管质量倡议 TCAR 监测项目的数据，将 TCAR 与血流逆转的结果与颈动脉内膜切除术（CEA）的金标准进行比较。
TCAR 是一种用于治疗高危颈动脉狭窄患者的新型微创血管重建术，与经股动脉途径的颈动脉支架置入术相比，其卒中发生率显著降低。
纳入在美国和加拿大接受 TCAR 和 CEA 治疗颈动脉狭窄的患者（2016-2019 年）。根据基线临床变量计算倾向评分，并用于匹配 2 种治疗组的患者（每组 n = 6384）。主要终点是围手术期卒中与/或死亡的联合结局。
在院内卒中/死亡方面，TCAR 与 CEA 之间无显著差异[TCAR，1.6%比 CEA，1.6%，RR（95%CI）：1.01（0.77-1.33），P = 0.945]、卒中[1.4%比 1.4%，RR（95%CI）：1.02（0.76-1.37），P = 0.881]或死亡[0.4%比 0.3%，RR（95%CI）：1.14（0.64-2.02），P = 0.662]。与 CEA 相比，TCAR 术后院内心肌梗死发生率较低[0.5%比 0.9%，RR（95%CI）：0.53（0.35-0.83），P = 0.005]、颅神经损伤发生率较低[0.4%比 2.7%，RR（95%CI）：0.14（0.08-0.23），P < 0.001]和术后高血压发生率较低[13%比 18.8%，RR（95%CI）：0.69（0.63-0.76），P < 0.001]。TCAR 组患者住院时间超过 1 天的比例也较低[26.4%比 30.1%，RR（95%CI）：0.88（0.82-0.94），P < 0.001]。在预测术后结局方面，未观察到手术和症状状态之间存在显著的交互作用。在 1 年时，2 组同侧卒中或死亡的发生率相似[HR（95%CI）：1.09（0.87-1.36），P = 0.44]。
这项倾向评分匹配分析表明，与 CEA 相比，TCAR 可显著降低术后心肌梗死和颅神经损伤的风险，而卒中/死亡的发生率无差异。
