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- Title
Transcarotid Revascularization Timing and Early Postoperative Outcomes in Symptomatic Patients.
- Authors
Pineau, Sylvestre; Fajardo, Andres; Saqib, Naveed U.; Tanaka, Akiko; Motaganahalli, Raghu L.; Keyhani, Arash; Keyhani, Kourosh; Wang, Keisin S.
- Abstract
Objective: Carotid endarterectomy (CEA) performed several days after onset of symptoms has been shown to be optimal in preventing procedure-related stroke. Transcarotid artery revascularization (TCAR) is an alternative hybrid procedure to treat high-risk for CEA patients. In this investigation, our aim is to determine the effect of timing of TCAR in symptomatic patients. Methods: Procedures were captured prospectively at 2 independent health systems from 2016-2022 within a carotid intervention database. A retrospective analysis of this database was performed to generate cohorts by time to revascularization from onset of symptoms, with the short-interval revascularization (SIR) group defined as having a time to revascularization between 2-5 days; and long-interval revascularization (LIR) group having a time to revascularization of 6-180 days. Univariate analysis was performed comparing the cohorts at an α of.05. Results: During the study period, 875 TCARs were captured, including 321 procedures performed in symptomatic patients. Of these, 84 had revascularization performed within 6 days after onset of symptoms (SIR) while 237 additional cases were completed 6 or more days after onset of symptoms (LIR). Baseline comorbidities were grossly similar between cohorts. Intraoperatively, SIR patients were less likely to develop bradycardia (4.8% vs 22.2%, P =.01) and experienced a shorter operative time (58 minutes vs 65 minutes, P =.02). Estimated blood loss, flow reversal time, radiation exposure, fluoroscopic time and contrast volume were identical between the groups. Length of stay in SIR patients was longer (1, IQR [1-3] vs 1, IQR [1-2] days, P <.01). Additionally, SIR patients seemed to trend toward a higher rate of reinterventions (3.6% vs.4%, P =.06). The incidence of ipsilateral or contralateral stroke, cranial nerve palsy, myocardial infarction, hematoma, stent thrombosis and death were statistically identical between the 2 groups. Conclusion: Like the previous results established for CEA, symptomatic patients undergoing TCAR demonstrate similar outcomes if the procedure is performed 48 hours after the neurologic event.
- Subjects
MYOCARDIAL infarction risk factors; SURGICAL complication risk factors; PARALYSIS -- Risk factors; HEMORRHAGE risk factors; MORTALITY risk factors; STROKE risk factors; THROMBOSIS risk factors; LENGTH of stay in hospitals; STATISTICS; HEMATOMA; REVASCULARIZATION (Surgery); CAROTID artery stenosis; TIME; CAROTID endarterectomy; RETROSPECTIVE studies; TREATMENT effectiveness; FLUOROSCOPY; AGE factors in disease; DESCRIPTIVE statistics; BRADYCARDIA; DISEASE risk factors
- Publication
Vascular & Endovascular Surgery, 2023, Vol 57, Issue 4, p344
- ISSN
1538-5744
- Publication type
Article
- DOI
10.1177/15385744221146678