A Systematic Review and Meta-Analysis of Transcarotid Artery Revascularization with Dynamic Flow Reversal Versus Transfemoral Carotid Artery Stenting and Carotid Endarterectomy

Naazie, Isaac; Cui, Christina; Osaghae, Ikponmwosa; Murad, Mohammad Hassan; Schermerhorn, Marc L.; Malas, Mahmoud B.

doi:10.1016/j.avsg.2020.05.070

Cited by 64 publications

(38 citation statements)

References 39 publications

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“…Finally, Naazie et al tried to compare TCAR and tfCAS in another review. 41 Like the present study, the authors found similar early event rates after TCAR, but they did not evaluate late outcomes and did not examine the effect of pre-operative symptoms. 41 Regarding the technical characteristics, it was found that the majority of patients underwent local/regional anaesthesia.…”

Section: Discussionmentioning

confidence: 46%

“…41 Like the present study, the authors found similar early event rates after TCAR, but they did not evaluate late outcomes and did not examine the effect of pre-operative symptoms. 41 Regarding the technical characteristics, it was found that the majority of patients underwent local/regional anaesthesia. This type of anaesthesia is very useful especially for patients of increased surgical risk that need to avoid general anaesthesia.…”

Section: Discussionmentioning

confidence: 46%

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Editor's Choice – Early and Late Outcomes after Transcarotid Revascularisation for Internal Carotid Artery Stenosis: A Systematic Review and Meta-Analysis

Galyfos

Tsoutsas

Konstantopoulos

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis systematic review summarises the evidence for transcarotid revascularisation (TCAR) in patients with internal carotid artery stenosis. This technique offers an alternative strategy in patients where carotid endarterectomy (CEA) or transfemoral stenting face difficulties. This review evaluates early and late outcomes of the method in contrast to other similar reviews. Data indicate that TCAR is safe and efficient although symptomatic patients still carry a higher risk of early cerebrovascular complications. Prospectively designed studies comparing outcomes between TCAR and CEA in symptomatic patients are needed to further evaluate the benefit of this technique.Objective: Transcarotid/transcervical revascularisation (TCAR) is an alternative to carotid endarterectomy (CEA) and transfemoral carotid stenting (tfCAS). This review aimed to evaluate pooled data on patients undergoing TCAR. Data sources: Medline, Embase, Scopus, and Cochrane Library databases were used. Review methods: This systematic review was conducted under Systematic Reviews and Meta-Analysis guidelines. Eligible studies (published online up to September 2020) reported 30 day mortality and stroke/transient ischaemic attack (TIA) rates in patients undergoing TCAR. Data were pooled in a random effects model and weight of effect for each study was also reported. Quality of studies was evaluated according to Newcastle e Ottawa scale. Results: Eighteen studies (three low, seven medium, and eight high quality) included 4 852 patients (4 867 TCAR procedures). The pooled 30 day mortality rate was 0.7% (n ¼ 32) (95% confidence interval [CI] 0.5 e 1.0), 30 day stroke rate 1.4% (n ¼ 62) (95% CI 1.0 e 1.7), and 30 day stroke/TIA rate 2.0% (n ¼ 92) (95% CI 1.4 e 2.7). Pooled technical success was 97.6% (95% CI 95.9 e 98.8). The cranial nerve injury rate was 1.2% (95% CI 0.7 e 1.9) (n ¼ 14; data from 10 studies) while the early myocardial infarction (MI) rate was 0.4% (95% CI 0.2 e 0.6) (n ¼ 16; data from 17 studies). The haematoma/bleeding rate was 3.4% (95% CI 1.7 e 5.8) (n ¼ 135; data from 10 studies), with one third of these cases needing drainage or intervention. Within a follow up of 3 e 40 months the restenosis rate was 4% (95% CI 0.1 e 13.1) (data from nine studies; n ¼ 64/530 patients) and death/stroke rate 4.5% (95% CI 1.8 e 8.4) (data from five studies; n ¼ 184/3 742 patients). Symptomatic patients had a higher risk of early stroke/TIA than asymptomatic patients (2.5% vs. 1.2%; odds ratio 1.99; 95% CI 1.01 e 3.92); p ¼ .046; data from eight studies). Conclusion: TCAR is associated with promising early and late outcomes, with symptomatic patients having a higher risk of early cerebrovascular events. More prospective comparative studies are needed in order to verify TCAR as an established alternative treatment technique.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 46%

Editor's Choice – Early and Late Outcomes after Transcarotid Revascularisation for Internal Carotid Artery Stenosis: A Systematic Review and Meta-Analysis

Galyfos

Tsoutsas

Konstantopoulos

et al. 2021

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

show abstract

“…23 Furthermore, a systematic review reported similar perioperative stroke/death rates after TCAR compared with CEA, although the review also stressed that larger prospective studies are needed to draw firmer conclusions. 24 The introduction of TCAR might provide the option of minimally invasive carotid revascularization in patient cohorts with characteristics that might limit treatment with TFCAS. One such potentially limiting factor is advanced age.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after transfemoral carotid artery stenting stratified by preprocedural symptom status

Solomon

Varkevisser

Swerdlow

et al. 2021

Journal of Vascular Surgery

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“…3 Several risk scores and risk prediction models have been developed in an attempt to identify ACS patient subgroups which may/may not benefit from a prophylactic carotid intervention. [4][5][6] These risk scores/ risk prediction models highlight the fact that the treatment of ACS patients may need to be individualized, preferably in high-volume institutes by high-volume surgeons/practitioners. [4][5][6] The development of more accurate methods able to predict ACS patients at "higher-risk for stroke" (like the authors propose) 7 are welcome.…”

mentioning

confidence: 99%

“…A recent logistic normal random effects meta-analysis of studies using the ENROUTE neuroprotection system (Silk Road Medical, Sunnyvale, Calif) reported a more realistic 30-day mortality rate of 0.76% and 30-day stroke rate of 1.34%. 6 Isaac N. Naazie, MD, MPH…”

mentioning

confidence: 99%

Regarding “An updated systematic review and meta-analysis of results of transcervical carotid artery stenting with flow reversal”

Naazie

Osaghae²,

Malas

2021

Journal of Vascular Surgery

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optimal management of patients with ACS. Both guidelines recognized the uncertainty in the management, as well as the excessive number of unnecessary interventions offered to these patients in the past. 2,3 Both guidelines 2,3 provided a strong recommendation for the implementation of best medical treatment in ACS patients, "regardless of the degree of stenosis or the plan for intervention". 2 The 2011 SVS guidelines clearly reported that the efficacy of a possible carotid intervention in ACS patients depends on minimizing perioperative complication rates, including appropriate risk factor assessment and patient selection, optimal perioperative therapy and performance of a technically excellent operation. 2 The 2018 ESVS guidelines further attempted to identify subgroups of patients at "higher risk for stroke" on best medical treatment who could benefit from an additional prophylactic carotid revascularization procedure. 3 After a critical review of the available literature, they proposed that the presence of one or more clinical and/or imaging features (eg, silent infarction on brain computed tomography/magnetic resonance imaging scans, stenosis progression, large plaque area, large juxta-luminal black area on computerized plaque analysis, plaque echolucency, intraplaque hemorrhage on magnetic resonance imaging, impaired cerebral vascular reserve and spontaneous embolization on transcranial Doppler monitoring) might be useful for selecting "higher-risk for stroke" patients for revascularization. 3 Several risk scores and risk prediction models have been developed in an attempt to identify ACS patient subgroups which may/may not benefit from a prophylactic carotid intervention. [4][5][6] These risk scores/ risk prediction models highlight the fact that the treatment of ACS patients may need to be individualized, preferably in high-volume institutes by high-volume surgeons/practitioners. [4][5][6] The development of more accurate methods able to predict ACS patients at "higher-risk for stroke" (like the authors propose) 7 are welcome. Nevertheless, these methods should first prove to be effective. The upcoming 2021 SVS guidelines for the management of patients with carotid stenosis are expected to help resolve the current controversies regarding the management of patients with ACS.

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A Systematic Review and Meta-Analysis of Transcarotid Artery Revascularization with Dynamic Flow Reversal Versus Transfemoral Carotid Artery Stenting and Carotid Endarterectomy

Cited by 64 publications

References 39 publications

Editor's Choice – Early and Late Outcomes after Transcarotid Revascularisation for Internal Carotid Artery Stenosis: A Systematic Review and Meta-Analysis

Editor's Choice – Early and Late Outcomes after Transcarotid Revascularisation for Internal Carotid Artery Stenosis: A Systematic Review and Meta-Analysis

Outcomes after transfemoral carotid artery stenting stratified by preprocedural symptom status

Regarding “An updated systematic review and meta-analysis of results of transcervical carotid artery stenting with flow reversal”

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