Primary mechanism of stroke reduction in transcarotid artery revascularization is dynamic flow reversal

Naazie, Isaac; Magee, Gregory A.; Mathlouthi, Asma; Elsayed, Nadin; Dakour-Aridi, Hanaa; Malas, Mahmoud B.

doi:10.1016/j.jvs.2020.10.082

Cited by 22 publications

(12 citation statements)

References 40 publications

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“…(17, 18) A recent retrospective comparative analysis between transfemoral CAS and TCAR concluded that the latter was associated to lower risk of procedural stroke due to dynamic flow reversal. (19) J o u r n a l P r e -p r o o f However, we believe this conclusion was mostly speculative as procedural stroke aetiology was not scrutinized in the cited study.…”

Section: Discussionmentioning

confidence: 96%

Critical analysis of the literature and standards of reporting on stroke after carotid revascularization

Coelho

Peixoto

Canedo

et al. 2022

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 96%

Critical analysis of the literature and standards of reporting on stroke after carotid revascularization

Coelho

Peixoto

Canedo

et al. 2022

Journal of Vascular Surgery

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“…Thirty-day ipsilateral stroke rates were higher in this study (2.4%) compared to other large studies of TCAR, such as ROADSTER (1.4%), Naazie et al (1.36%) and Malas et al (1.29%). 8,11,12 This is not due to the difference in definition of stroke, as our study had a more restrictive definition compared to others. For example, in the study by Malas and Naazie, stroke was defined as neurological symptoms greater than 24 hours, with or without imaging confirmation.…”

Section: Discussionmentioning

confidence: 79%

Dual Institutional Experience with Transcarotid Artery Revascularization

George

Husman

Dakour-Aridi

et al. 2022

Vasc Endovascular Surg

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Introduction Transcarotid artery revascularization (TCAR) is a hybrid open and endovascular technique to treat carotid stenosis. The purpose of this study is to present a large cohort of patients who underwent TCAR at 2 high-volume TCAR health systems. Methods This study was a retrospective chart review of all instances of TCAR within the Memorial Hermann Health System and Indiana University Health, from December 2015-January 2022, using the ENROUTE Neuroprotection Device (Silk Road Medical, Sunnyvale, CA). We report patient demographics, intraoperative metrics, 30-day results and long-term results. Results In all, 750 patients underwent TCAR in the designated time period. Average patient age was 73 years, with 68% being male. Overall, 53.9% of patients had coronary artery disease, 45.4% had diabetes, and 36.9% were symptomatic. Technical success was achieved in 98.8% of patients with conversion to open endarterectomy in 1.1%. Average reverse flow time was 9.1 minutes with length of stay greater than 1 day 38%. Ipsilateral stroke rate within 30 days was 2.3% and long-term cumulative stroke rate was 3.0%. Death within 30 days occurred in 1.2% of patients and in 5.9% over long-term follow up. In all, 1% of patients required reintervention. Conclusions TCAR is a safe and effective treatment modality for carotid artery stenotic disease. Its outcomes are similar to historical results associated with carotid endarterectomy, long considered the gold standard.

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“…Only a few included studies have presented a slightly higher stroke rate for TCAR compared to CEA, though this may due to patient selection or the relatively small sample size (34). The reduction of neurological risks from TF-CAS to TCAR, to a great extent, is associated with the use of flow reversal, which is a protected device driving thrombus to femoral vein based on arterio-venous pressure, meanwhile, directly carotid puncture avoiding manipulation in the aortic arch is another beneficial factor (48,49).…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Transcarotid Artery Revascularization With Flow Reversal System Compared to Carotid Endarterectomy: A Systematic Review and Meta-Analysis

Gao

Chen

Kou

et al. 2021

Front. Cardiovasc. Med.

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Background: Carotid artery stenosis has long been a critical cause of stroke and death, and it can seriously affect the life quality. Transcarotid artery revascularization (TCAR) and carotid endarterectomy (CEA) are both feasible therapies for this disease. This systematic review and meta-analysis aim to evaluate if the efficacy of the two approaches is comparable.Methods: Clinical studies up to March 2021 were searched through PubMed, Embase, and Scopus from a computer. The screening process was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Newcastle-Ottawa Scale (NOS) was used for methodological quality assessment of works of literature meeting the inclusion criteria, and Review Manager 5.4 was used for data synthesis. The I2 statistic was performed to measure the heterogeneity, and M-H/I-V fixed or random model was utilized depending on the I2 value. The evidence evaluation was accomplished based on grades of recommendation, assessment, development, and evaluation (GRADE) online tool.Results: A total of 14,200 subjects (six comparative studies) were finally included in this pooled study. There is no statistical discrepancy between the two treatments on reducing stroke/death/myocardial infarction (odds ratio [OR] 0.85, 95% CI 0.67–1.07), stroke (OR 1.03, 95% CI 0.77–1.37), or death (OR 1.14, 95% CI 0.67–1.94). Besides, TCAR is associated with a lower incidence of myocardial infarction (P = 0.004), cranial nerve injury (P < 0.00001), and shorter procedure time (P < 0.00001) than CEA among the overall cohort.Conclusions: TCAR is a rapidly developing treatment that reaches a comparable prognosis to CEA and significantly reduces the risk of myocardial infarction under the well-matched condition, which is a dependable choice for patients with carotid stenosis.

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Primary mechanism of stroke reduction in transcarotid artery revascularization is dynamic flow reversal

Cited by 22 publications

References 40 publications

Critical analysis of the literature and standards of reporting on stroke after carotid revascularization

Critical analysis of the literature and standards of reporting on stroke after carotid revascularization

Dual Institutional Experience with Transcarotid Artery Revascularization

The Efficacy of Transcarotid Artery Revascularization With Flow Reversal System Compared to Carotid Endarterectomy: A Systematic Review and Meta-Analysis

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