Transcarotid Artery Revascularization Results in Low Rates of Periprocedural Neurologic Events, Myocardial Infarction, and Death
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Purpose of Review
Transcarotid artery revascularization (TCAR) is a novel hybrid procedure that reverses carotid flow and places a stent using surgical access of the carotid artery in the neck under local anesthesia. We discuss the indications for carotid revascularization, the clinical rationale for TCAR, and evidence for its potential role in the management of carotid stenosis.
Results from pre-clinical studies, prospective single-arm studies, and comparative analyses of registry data indicate that TCAR results in low amounts of periprocedural microembolization, cerebral lesions detectable on magnetic resonance imaging, and neurologic events, myocardial infarctions (MIs), and death.
Non-randomized comparisons suggest that TCAR may offer a novel solution to reducing periprocedural stroke, death, and MI in patients with carotid stenosis. A state of equipoise appears to have been reached with TCAR versus the traditional carotid revascularization procedures and a well-controlled randomized trial with careful oversight should be prioritized to obtain level 1 evidence.
KeywordsCarotid artery Transcarotid Revascularization Flow reversal
CREST-2 is funded by the National Institute of Neurological Disorders and Stroke through two U01 awards: U01 NS080168 and U01 NS08016. CREST-2 Registry is funded by NINDS-NIH and by Abbott Vascular, Boston Scientific, Cordis-Cardinal, W. L. Gore and Associates, Medtronic and Silk Road Medical.
Compliance with Ethical Standards
Conflict of Interest
Angelica R. Lackey, Young Erben, Joao Antonio Da Rocha Franco, James F. Meschia, and Brajesh K. Lal declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
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