In the Journals

TCAR as effective as surgery, with less cranial nerve injury

In a retrospective analysis, transcarotid artery revascularization yielded similar outcomes to carotid endarterectomy but was linked with less risk for cranial nerve injury in patients with carotid artery disease.

The researchers analyzed 292 patients who underwent TCAR (Enroute Transcarotid Neuroprotection System, Silk Road Medical) at four institutions between 2013 and 2017 and matched them based on preoperative comorbidities with 292 patients who underwent carotid endarterectomy.

In the matched cohort, patients who had TCAR were more likely to be treated with clopidogrel (preoperatively, 82.2% vs. 39.4%; P < .01; postoperatively, 98.3% vs. 36%; P < .01) and statins (preoperatively, 88% vs. 75%; P < .01; postoperatively, 97.8% vs. 78.8%; P < .01), Vikram S. Kashyap, MD, FACS, professor of surgery and chief of the division of vascular surgery and endovascular therapy at University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, and colleagues wrote.

At 30 days, rates of stroke (TCAR, 1%; surgery, 0.3%; P = .62) and death (TCAR, 0.3%; surgery, 0.7%) were similar, and the same was true at 1 year (stroke: TCAR, 2.8%; surgery, 2.2%; P = .79; death: TCAR, 1.8%; surgery, 4.5%; P = .09), according to the researchers.

The rate of stroke, death or MI at 1 month was also similar between the groups (TCAR, 2.1%; surgery, 1.7%).

However, cranial nerve injury was lower in the TCAR group (0.3% vs. 3.8%; P = .01), Kashyap and colleagues wrote.

Patients undergoing TCAR seem to have broadly similar rates of stroke, MI and death when compared with patients undergoing [carotid endarterectomy] in the same institutions by the same surgeons,” the researchers wrote. “TCAR may mitigate the risk of cranial nerve injuries. Further comparative studies evaluating TCAR in both high-risk and standard-risk surgical patients are warranted.” – by Erik Swain

Disclosures: Kashyap reports he is national principal investigator for a trial sponsored by Silk Road Medical and received proctor fees from Silk Road Medical. Two other authors report they have financial ties with Silk Road Medical.

 

In a retrospective analysis, transcarotid artery revascularization yielded similar outcomes to carotid endarterectomy but was linked with less risk for cranial nerve injury in patients with carotid artery disease.

The researchers analyzed 292 patients who underwent TCAR (Enroute Transcarotid Neuroprotection System, Silk Road Medical) at four institutions between 2013 and 2017 and matched them based on preoperative comorbidities with 292 patients who underwent carotid endarterectomy.

In the matched cohort, patients who had TCAR were more likely to be treated with clopidogrel (preoperatively, 82.2% vs. 39.4%; P < .01; postoperatively, 98.3% vs. 36%; P < .01) and statins (preoperatively, 88% vs. 75%; P < .01; postoperatively, 97.8% vs. 78.8%; P < .01), Vikram S. Kashyap, MD, FACS, professor of surgery and chief of the division of vascular surgery and endovascular therapy at University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, and colleagues wrote.

At 30 days, rates of stroke (TCAR, 1%; surgery, 0.3%; P = .62) and death (TCAR, 0.3%; surgery, 0.7%) were similar, and the same was true at 1 year (stroke: TCAR, 2.8%; surgery, 2.2%; P = .79; death: TCAR, 1.8%; surgery, 4.5%; P = .09), according to the researchers.

The rate of stroke, death or MI at 1 month was also similar between the groups (TCAR, 2.1%; surgery, 1.7%).

However, cranial nerve injury was lower in the TCAR group (0.3% vs. 3.8%; P = .01), Kashyap and colleagues wrote.

Patients undergoing TCAR seem to have broadly similar rates of stroke, MI and death when compared with patients undergoing [carotid endarterectomy] in the same institutions by the same surgeons,” the researchers wrote. “TCAR may mitigate the risk of cranial nerve injuries. Further comparative studies evaluating TCAR in both high-risk and standard-risk surgical patients are warranted.” – by Erik Swain

Disclosures: Kashyap reports he is national principal investigator for a trial sponsored by Silk Road Medical and received proctor fees from Silk Road Medical. Two other authors report they have financial ties with Silk Road Medical.