What is the prognosis for transcarotid artery revascularization (TCAR) for atherosclerotic disease of the carotid artery?

Updated: Sep 29, 2021
  • Author: Jake F Hemingway, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Transcarotid artery revascularization

Transcarotid artery revascularization (TCAR) represents an alternative to CAS in which the risk of navigating the often diseased atherosclerotic arch is eliminated through the use of direct, open surgical access to the proximal common carotid artery. Additionally, the use of flow reversal as embolic protection allows the institution of cerebral protection before the lesion is engaged, which has been shown to be the primary mechanism of stroke reduction in TCAR. [14]

The initial ROADSTER 1 and 2 trials evaluating the 30-day and 1-year safety of TCAR demonstrated high technical success rates (96.5%) and favorable safety outcomes, with a 30-day ipsilateral stroke rate of 1.4%, a 1-year ipsilateral stroke rate of 0.4%, respectively, a composite 30-day stroke/death rates of 2.3%, and a stroke/MI/death rates of 3.2%. [15, 16]  

Multiple studies have demonstrated the safety of TCAR in comparison with both CEA and transfemoral CAS. Observational comparative registry studies evaluating TCAR and CEA among patients entered into the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) TCAR Surveillance Project (TSP) registry and the CEA database, respectively, demonstrated comparable stroke/death rates among patients undergoing TCAR as compared with CEA, despite higher rates of medical comorbid conditions. [17]

Other comparative studies evaluating in-hospital outcomes of TCAR and transfemoral CAS demonstrated that patients undergoing TCAR, despite having higher rates of comorbid conditions, had a significantly lower risk of stroke or death. [18, 19]

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