Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX.
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX.
J Vasc Surg. 2022 Oct;76(4):967-972. doi: 10.1016/j.jvs.2022.04.028. Epub 2022 May 28.
In the present report, we have detailed the results derived from the adoption of transcarotid artery revascularization (TCAR) at a large health system based in the United States.
A retrospective review was performed of a prospectively maintained database capturing all carotid stents deployed using the ENROUTE neuroprotection device (Silk Road Medical, Sunnyvale, CA) and cerebral flow reversal. The demographics, intraoperative findings, and postoperative results were tabulated and reported.
From September 2017 to December 2021, 429 TCAR procedures were attempted within the Memorial Hermann Health System. Preoperatively, all the patients were either asymptomatic with >70% stenosis (66.9%) or symptomatic with >50% stenosis (33.1%). The degree of stenosis was determined using computed tomography angiography and/or duplex ultrasound. We achieved a technical success rate of 99.1%, with the failures attributed to an inability to cross the lesion, an inability to track the stent, visualization of a flow-limiting dissection, and stent maldeployment for one patient each. During the 30-day perioperative period, nine strokes (2.3%) had occurred, three of which had occurred after discharge from the index operation and before the end of the 30-day period. No patient had experienced myocardial infarction. Five patients had died in the perioperative period. Three of the deaths were related to stroke, and two were attributed to cardiopulmonary events secondary to aspiration and likely pulmonary embolus. The mean follow-up after TCAR was 14.5 ± 12.0 months. During the follow-up period, two patients had required reintervention for in-stent stenosis. Ipsilateral to the implanted carotid stent, the overall (including perioperative) stroke incidence was 2.5%. Contralateral to the stent, the stroke incidence was 0.8%. The myocardial infarction rate was 0.8% during follow-up. Mortality in our study population was 5.1% during the follow-up period.
After adoption of TCAR across the Memorial Hermann Health System, we found this procedure to be safe and efficacious with minimal perioperative risks comparable to the historically reported results associated with alternative carotid interventions.
在本报告中，我们详细介绍了美国一家大型医疗机构采用经颈动脉血管重建术（TCAR）的结果。
对使用 ENROUTE 神经保护装置（Silk Road Medical，加利福尼亚州森尼韦尔）和脑血流反转进行颈动脉支架置入的前瞻性维护数据库进行回顾性分析。记录并报告患者的人口统计学、术中发现和术后结果。
在 Memorial Hermann 健康系统中，2017 年 9 月至 2021 年 12 月共尝试进行了 429 例 TCAR 手术。术前，所有患者均为无症状性狭窄>70%（66.9%）或有症状性狭窄>50%（33.1%）。狭窄程度通过计算机断层血管造影和/或双功能超声确定。我们的技术成功率为 99.1%，失败的原因是无法穿过病变、无法跟踪支架、发现限制血流的夹层以及 1 例支架放置不当。在 30 天围手术期内，发生了 9 例中风（2.3%），其中 3 例发生在指数手术后出院至 30 天期末。无患者发生心肌梗死。5 例患者在围手术期死亡。其中 3 例死亡与中风有关，2 例归因于吸入性心肺事件和可能的肺栓塞。TCAR 后平均随访 14.5±12.0 个月。在随访期间，2 例患者因支架内狭窄需要再次介入治疗。在植入颈动脉支架的同侧，总的（包括围手术期）中风发生率为 2.5%。在支架对侧，中风发生率为 0.8%。在随访期间，心肌梗死发生率为 0.8%。在随访期间，我们的研究人群死亡率为 5.1%。
在 Memorial Hermann 健康系统中采用 TCAR 后，我们发现该手术安全有效，围手术期风险极小，与替代颈动脉干预相关的历史报告结果相似。
