AbuRahma Ali F, Santini Adrian, AbuRahma Zachary T, Lee Andrew, Seal Kimberly, Veith Christina, Dean Scott, Davis Elaine
From the Department of Surgery, West Virginia University, Charleston, WV (AF AbuRahma, Santini, ZT AbuRahma, Lee, Seal, Veith).
the Charleston Area Medical Center Health Education and Research Institute, Charleston, WV (Dean, Davis).
J Am Coll Surg. 2023 Apr 1;236(4):668-674. doi: 10.1097/XCS.0000000000000543. Epub 2023 Jan 9.
Transcarotid artery revascularization (TCAR) has been proposed as a alternative to carotid endarterectomy (CEA) and transfemoral carotid artery stenting in high-risk patients. Recently Centers for Medicare and Medicaid Services expanded coverage for TCAR to include standard surgical risk patients within the Society of Vascular Surgery Vascular Quality Initiative TCAR Surveillance Project. Few single centers compared the clinical outcome of TCAR with CEA. This study compares 30-day perioperative clinical outcomes between TCAR and CEA.
This is retrospective analysis of prospectively collected data from the TCAR Surveillance Project of TCAR patients enrolled in our institution and compared with CEAs done in the same time/with the same providers. The primary outcome was stroke and/or death. Secondary outcomes included stroke, death, MI, cranial nerve injury, bleeding, and others. Propensity matching was done to analyze outcomes.
The study analyzed 501 patients (347 CEA, 154 TCAR). There were no significant differences in symptomatic status (43% for CEA vs 38% for TCAR, p = 0.303). TCAR had more patients with hypertension (p = 0.04), coronary artery disease (p = 0.028), and congestive heart failure (p = 0.039). The 30-day perioperative complication rates for CEA vs TCAR were as follows: stroke 1% vs 3% (p = 0.142), stroke/death 1% vs 3% (p = 0.185), MI 0.6% vs 0.7% (p = 1), death 0.6% vs 0% (p = 1), stroke/death/MI 2% vs 4% (p = 0.233), cranial nerve injury 4% vs 2% (p = 0.412), and major hematoma (requiring reintervention) 2% vs 3% (p = 1). After matching 154 CEA patients and 154 TCAR, 30-day perioperative complication rates were as follows: stroke 2% vs 3% (p = 0.723), stroke/death 3% vs 3% (p = 1), death 1.3% vs 0% (p = 0.498), MI 0.7% vs 0.7% (p = 1), and stroke/death/MI 3% vs 4% (p = 0.759).
This study showed that using propensity match analysis, both CEA and TCAR have similar 30-day perioperative outcomes. Further long-term data are needed.
经颈动脉血管重建术（TCAR）已被提议作为高危患者颈动脉内膜切除术（CEA）和经股动脉颈动脉支架置入术的替代方案。最近，医疗保险和医疗补助服务中心扩大了对TCAR的覆盖范围，将血管外科学会血管质量倡议TCAR监测项目中的标准手术风险患者纳入其中。很少有单中心比较TCAR与CEA的临床结果。本研究比较了TCAR和CEA围手术期30天的临床结果。
这是一项对前瞻性收集的来自我们机构TCAR监测项目的TCAR患者数据进行的回顾性分析，并与同一时间/由相同医疗人员进行的CEA进行比较。主要结局是卒中及/或死亡。次要结局包括卒中、死亡、心肌梗死、颅神经损伤、出血等。采用倾向匹配法分析结局。
该研究分析了501例患者（347例CEA，154例TCAR）。症状状态无显著差异（CEA为43%，TCAR为38%，p = 0.303）。TCAR患者中高血压（p = 0.04）、冠状动脉疾病（p = 0.028）和充血性心力衰竭（p = 0.039）的患者更多。CEA与TCAR围手术期30天并发症发生率如下：卒中1%对3%（p = 0.142），卒中/死亡1%对3%（p = 0.185），心肌梗死0.6%对0.7%（p = 1），死亡0.
