DOI: 10.1161/str.55.suppl_1.wp268 ISSN: 0039-2499

Abstract WP268: Transcarotid Arterial Revascularization of Symptomatic Internal Carotid Artery Disease: A Systematic Review and Meta-Analysis

Malik Ghannam, Mohammad Almajali, Abdullah Al Qudah, Farid Khasiyev, Mahmoud Dibas, Dana Ghazaleh, Hannah Roeder, Nils Henninger, Adam H de Havenon, Colin P Derdeyn, Enrique C Leira, Seemant Chaturvedi, Shadi Yaghi
  • Advanced and Specialized Nursing
  • Cardiology and Cardiovascular Medicine
  • Neurology (clinical)

Introduction: TCAR is an interventional therapy for symptomatic ICA disease. Currently, the utilization of TCAR is contentious due to limited evidence. We conducted a comprehensive systematic review and meta-analysis utilizing existing studies to evaluate the postoperative outcomes and complications of TCAR as compared to CAS and CEA for patients with symptomatic ICA disease.

Methods: A systematic review was conducted, spanning from January 2000 to February 2023, encompassing studies that employed TCAR for the treatment of symptomatic ICA disease. The primary outcomes included 30-day combined stroke and transient ischemic attack (TIA), myocardial infarction (MI), and mortality. This was explained in Figure 1.

Results: A total of seven studies involving 24,246 patients were analyzed. Compared to CAS, TCAR was associated with a similar rate of stroke and TIA (OR:0.77,95%CI:0.33-1.82), and MI (OR:1.29,95%CI:0.83-2.01) but lower mortality (OR:0.42,95%CI:0.22-0.81). In patients, ≥80 years, the rate of stroke and TIA was lower with TCAR compared to CAS (OR:0.47,95%CI:0.35-0.65). When compared to CEA, TCAR was associated with a higher rate of stroke and TIA (OR:1.26,95%CI:1.03-1.54) but without differing rates of MI (OR:0.9,95%CI:0.64-1.38), and mortality (OR:1.35,95%CI:0.87-2.10). this was explained in figure 2.

Conclusions: Although CEA has traditionally been considered superior to stenting for symptomatic carotid stenosis, TCAR may have some advantages over CAS, particularly in the elderly population (≥80 years). Prospective randomized trials comparing the three modalities are needed.

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