Meeting News

Transcarotid artery revascularization beneficial in real-world population

Marc L. Schermerhorn
Marc L. Schermerhorn

In a real-world population, transcarotid artery revascularization had similar outcomes to carotid endarterectomy and better outcomes than transfemoral carotid artery stenting, according to data presented at VEITHSymposium.

The ROADSTER trial showed that transcarotid artery revascularization (TCAR) with a transcarotid neuroprotective system (Enroute, Silk Road Medical) was associated with low rates of stroke and death, but real-world data were lacking, Marc L. Schermerhorn, MD, chief of the division of vascular and endovascular surgery at Beth Israel Deaconess Medical Center, told Cardiology Today’s Intervention.

“There are limited data on TCAR outside of the highly selected patients in clinical trials,” he said during an interview. “This study allows us to make a real-world comparison between TCAR and the standard surgical carotid endarterectomy. This study highlights the utility of the Society for Vascular Surgery’s Vascular Quality Initiative to evaluate new technology.”

The researchers analyzed 43,114 patients who had carotid endarterectomy (mean age, 71 years), 9,460 patients who had transfemoral CAS (mean age, 70 years) and 2,545 patients who had TCAR (mean age, 73 years) from January to September 2016.

After adjustment, compared with the transfemoral CAS group, the TCAR group had lower risk for in-hospital stroke/death (OR = 0.3; 95% CI, 0.2-0.5), in-hospital stroke/death/MI (OR = 0.4; 95% CI, 0.3-0.5), in-hospital stroke (OR = 0.5; 95% CI, 0.3-0.8), in-hospital death (OR = 0.2; 95% CI, 0.1-0.3) and 30-day death (OR = 0.3; 95% CI, 0.2-0.4), according to the researchers. The groups had similar rates of in-hospital MI and bleeding.

The differences were observed in symptomatic and asymptomatic patients, according to the researchers.

After adjustment, compared with the carotid endarterectomy group, the TCAR group had reduced risk for cranial nerve injury (OR = 0.1; 95% CI, 0-0.2) and similar risk for in-hospital stroke/death, in-hospital stroke/death/MI, in-hospital stroke, in-hospital death, 30-day death, in-hospital MI and in-hospital bleeding, Schermerhorn and colleagues found.

“Despite an older, sicker patient population, TCAR did just as well as [carotid endarterectomy] — rates of in-hospital stroke or death were comparable to [carotid endarterectomy] (TCAR, 1.8%; [carotid endarterectomy], 1.4%; P = .09),” Schermerhorn said during an interview. “Of note, however, was a 10-fold reduction in cranial nerve injury. In addition, shorter procedure times (by 41 minutes) and less extended hospital stays benefit hospitals by being able to increase utilization of the ORs.”

“Our subset analysis showed that octogenarians do really well with TCAR,” Schermerhorn said during an interview. “Typically, this is a vulnerable patient population that performs worse in terms of stroke and stroke/death with both [carotid endarterectomy] and CAS, but we saw no increase in stroke or death rates for octogenarians (< 80 years, 1.8%; > 80 years, 1.7%; P = .8). As a result, TCAR’s minimally invasive approach with excellent neuroprotection seems ideal for these patients.” – by Erik Swain

Reference:

Schermerhorn ML, et al. Session 21: Hot New Topics Related to Lower Extremity or Carotid Treatments. Presented at: VEITHSymposium; Nov. 13-17, 2018; New York.

Disclosure: Schermerhorn reports no relevant financial disclosures.

Marc L. Schermerhorn
Marc L. Schermerhorn

In a real-world population, transcarotid artery revascularization had similar outcomes to carotid endarterectomy and better outcomes than transfemoral carotid artery stenting, according to data presented at VEITHSymposium.

The ROADSTER trial showed that transcarotid artery revascularization (TCAR) with a transcarotid neuroprotective system (Enroute, Silk Road Medical) was associated with low rates of stroke and death, but real-world data were lacking, Marc L. Schermerhorn, MD, chief of the division of vascular and endovascular surgery at Beth Israel Deaconess Medical Center, told Cardiology Today’s Intervention.

“There are limited data on TCAR outside of the highly selected patients in clinical trials,” he said during an interview. “This study allows us to make a real-world comparison between TCAR and the standard surgical carotid endarterectomy. This study highlights the utility of the Society for Vascular Surgery’s Vascular Quality Initiative to evaluate new technology.”

The researchers analyzed 43,114 patients who had carotid endarterectomy (mean age, 71 years), 9,460 patients who had transfemoral CAS (mean age, 70 years) and 2,545 patients who had TCAR (mean age, 73 years) from January to September 2016.

After adjustment, compared with the transfemoral CAS group, the TCAR group had lower risk for in-hospital stroke/death (OR = 0.3; 95% CI, 0.2-0.5), in-hospital stroke/death/MI (OR = 0.4; 95% CI, 0.3-0.5), in-hospital stroke (OR = 0.5; 95% CI, 0.3-0.8), in-hospital death (OR = 0.2; 95% CI, 0.1-0.3) and 30-day death (OR = 0.3; 95% CI, 0.2-0.4), according to the researchers. The groups had similar rates of in-hospital MI and bleeding.

The differences were observed in symptomatic and asymptomatic patients, according to the researchers.

After adjustment, compared with the carotid endarterectomy group, the TCAR group had reduced risk for cranial nerve injury (OR = 0.1; 95% CI, 0-0.2) and similar risk for in-hospital stroke/death, in-hospital stroke/death/MI, in-hospital stroke, in-hospital death, 30-day death, in-hospital MI and in-hospital bleeding, Schermerhorn and colleagues found.

“Despite an older, sicker patient population, TCAR did just as well as [carotid endarterectomy] — rates of in-hospital stroke or death were comparable to [carotid endarterectomy] (TCAR, 1.8%; [carotid endarterectomy], 1.4%; P = .09),” Schermerhorn said during an interview. “Of note, however, was a 10-fold reduction in cranial nerve injury. In addition, shorter procedure times (by 41 minutes) and less extended hospital stays benefit hospitals by being able to increase utilization of the ORs.”

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“Our subset analysis showed that octogenarians do really well with TCAR,” Schermerhorn said during an interview. “Typically, this is a vulnerable patient population that performs worse in terms of stroke and stroke/death with both [carotid endarterectomy] and CAS, but we saw no increase in stroke or death rates for octogenarians (< 80 years, 1.8%; > 80 years, 1.7%; P = .8). As a result, TCAR’s minimally invasive approach with excellent neuroprotection seems ideal for these patients.” – by Erik Swain

Reference:

Schermerhorn ML, et al. Session 21: Hot New Topics Related to Lower Extremity or Carotid Treatments. Presented at: VEITHSymposium; Nov. 13-17, 2018; New York.

Disclosure: Schermerhorn reports no relevant financial disclosures.