Marios Sagris1, Stefanos Giannopoulos2, Spyridon Giannopoulos3, Andreas Tzoumas4, Pavlos Texakalidis5, Nektarios Charisis6, Damianos G Kokkinidis7, Rafael D Malgor8, Nicolas J Mouawad9, Christos Bakoyiannis3. 1. General Hospital of Nikaia, Piraeus, Athens, Greece. 2. Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA. Electronic address: stefanosgiannopoulosmed@gmail.com. 3. First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece. 4. Aristotle University of Thessaloniki, Thessaloniki, Greece. 5. Department of Neurosurgery, Northwestern University, Chicago, IL, USA. 6. Department of Surgery, Stonybrook University, Stonybrook, NY, USA. 7. Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. 8. Anschutz Medical Center, Division of Vascular Surgery and Endovascular Therapy, University of Colorado, Aurora, CO, USA. 9. Michigan State University, East Lansing, MI, USA.
Abstract
OBJECTIVE: Carotid artery stenosis is a determinant factor accused for cerebrovascular events, estimated to be the cause of 10-20% of all ischemic strokes. Trans-cervical carotid artery revascularization (TCAR) has been offered as an alternative to transfemoral carotid artery stenting and carotid endarterectomy. METHODS: A systematic review and meta-analysis of prospective and retrospective studies reporting on outcomes of patients undergoing TCAR for carotid stenosis was conducted. The incidence of periprocedural adverse events is calculated. RESULTS: In total, 49 studies including 14,588 patients met the predefined eligibility criteria and were included in this meta-analysis. Technical success was 99% (95% CI: 98%-99%). Reasons for technical failure included inability to cross the lesion and/or failure to deploy the stent. Access site complications occurred in 2% (30 studies; 95% CI: 1%-2%) of all the cases. Overall, cranial nerve (CN) injuries were very rare, with only 33 patients out of 8,994 experiencing neurologic deficits attributed to CN involvement. Bleeding complications were reported by 20 studies and occurred in 2% (95% CI: 1%-3%) of all cases. Overall periprocedural all-cause mortality and stroke was 0.5% and 1.3% respectively. In-stent restenosis was observed in 4 out of 260 patients (7 studies; 1.5%), while early (30-day) re-occlusion/acute thrombosis of the target lesion occurred in approximately 1% (11 studies; N=12/1,243). CONCLUSION: This study provided significant evidence that TCAR is a very promising and safe carotid revascularization approach demonstrating favorable technical success rates associated with low periprocedural stroke and CN injury rates.
OBJECTIVE: Carotid artery stenosis is a determinant factor accused for cerebrovascular events, estimated to be the cause of 10-20% of all ischemic strokes. Trans-cervical carotid artery revascularization (TCAR) has been offered as an alternative to transfemoral carotid artery stenting and carotid endarterectomy. METHODS: A systematic review and meta-analysis of prospective and retrospective studies reporting on outcomes of patients undergoing TCAR for carotid stenosis was conducted. The incidence of periprocedural adverse events is calculated. RESULTS: In total, 49 studies including 14,588 patients met the predefined eligibility criteria and were included in this meta-analysis. Technical success was 99% (95% CI: 98%-99%). Reasons for technical failure included inability to cross the lesion and/or failure to deploy the stent. Access site complications occurred in 2% (30 studies; 95% CI: 1%-2%) of all the cases. Overall, cranial nerve (CN) injuries were very rare, with only 33 patients out of 8,994 experiencing neurologic deficits attributed to CN involvement. Bleeding complications were reported by 20 studies and occurred in 2% (95% CI: 1%-3%) of all cases. Overall periprocedural all-cause mortality and stroke was 0.5% and 1.3% respectively. In-stent restenosis was observed in 4 out of 260 patients (7 studies; 1.5%), while early (30-day) re-occlusion/acute thrombosis of the target lesion occurred in approximately 1% (11 studies; N=12/1,243). CONCLUSION: This study provided significant evidence that TCAR is a very promising and safe carotid revascularization approach demonstrating favorable technical success rates associated with low periprocedural stroke and CN injury rates.
Authors: Zachary K Christian; Alex N Hoang; Huy Dang; Abdul B Khan; Daniel M S Raper; Zachary S Pallister; Omar Tanweer Journal: J Neurosurg Case Lessons Date: 2022-03-07