Safety and Efficacy of Transcarotid Artery Revascularization in a Community Hospital

Abstract Objective Evaluate the outcomes and complications of transcarotid artery revascularization (TCAR) outside of academic vascular surgery programs. Methods An IRB approved retrospective study was performed. Data from all cases of TCAR performed at a community hospital between May 2017 and February 2020 was collected and analyzed. Seven vascular surgeons performed the procedures after receiving appropriate training. The primary outcomes included technical success, need for further revascularization, and major adverse events (death, cerebrovascular accident [CVA], myocardial infarction [MI]). Secondary outcomes included other adverse events and complications. Outcomes were assessed in the perioperative and 30-day follow-up periods. Results Over a 33-month period, TCAR was completed in 147 out of 149 (98.7%) attempted cases. No patients required further revascularization. The perioperative and 30-day major adverse event rates were 0.7% (n = 1) and 3.4% (n = 5), respectively. There was one case of a minor perioperative CVA. At 30-days, there was one mortality. 30-day complications included CVA (n=1) and MI (n=3). The combined perioperative and 30-day minor complication rates were 2.7% and 1.4%, respectively. Conclusions TCAR is a safe and effective method of carotid artery revascularization in a community hospital setting. This technology may help improve revascularization in patients without access to larger academic centers.