Angelica R Lackey1, Young Erben2, Joao Antonio Da Rocha Franco2, James F Meschia2, Brajesh K Lal3. 1. Department of Vascular Surgery, University of Maryland, 22 South Greene Street, S10-B00, Baltimore, MD, 21201, USA. 2. Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. 3. Department of Vascular Surgery, University of Maryland, 22 South Greene Street, S10-B00, Baltimore, MD, 21201, USA. blal@som.umaryland.edu.
Abstract
PURPOSE OF REVIEW: Transcarotid artery revascularization (TCAR) is a novel hybrid procedure that reverses carotid flow and places a stent using surgical access of the carotid artery in the neck under local anesthesia. We discuss the indications for carotid revascularization, the clinical rationale for TCAR, and evidence for its potential role in the management of carotid stenosis. RECENT FINDINGS: Results from pre-clinical studies, prospective single-arm studies, and comparative analyses of registry data indicate that TCAR results in low amounts of periprocedural microembolization, cerebral lesions detectable on magnetic resonance imaging, and neurologic events, myocardial infarctions (MIs), and death. Non-randomized comparisons suggest that TCAR may offer a novel solution to reducing periprocedural stroke, death, and MI in patients with carotid stenosis. A state of equipoise appears to have been reached with TCAR versus the traditional carotid revascularization procedures and a well-controlled randomized trial with careful oversight should be prioritized to obtain level 1 evidence.
RCT Entities:
PURPOSE OF REVIEW: Transcarotid artery revascularization (TCAR) is a novel hybrid procedure that reverses carotid flow and places a stent using surgical access of the carotid artery in the neck under local anesthesia. We discuss the indications for carotid revascularization, the clinical rationale for TCAR, and evidence for its potential role in the management of carotid stenosis. RECENT FINDINGS: Results from pre-clinical studies, prospective single-arm studies, and comparative analyses of registry data indicate that TCAR results in low amounts of periprocedural microembolization, cerebral lesions detectable on magnetic resonance imaging, and neurologic events, myocardial infarctions (MIs), and death. Non-randomized comparisons suggest that TCAR may offer a novel solution to reducing periprocedural stroke, death, and MI in patients with carotid stenosis. A state of equipoise appears to have been reached with TCAR versus the traditional carotid revascularization procedures and a well-controlled randomized trial with careful oversight should be prioritized to obtain level 1 evidence.
Authors: Pavel Kibrik; David P Stonko; Ahmad Alsheekh; Courtenay Holscher; Devin Zarkowsky; Christopher J Abularrage; Caitlin W Hicks Journal: J Vasc Surg Date: 2022-05-25 Impact factor: 4.860