Transcarotid Artery Revascularization With Flow Reversal As A Novel Method For Carotid Artery Stenosis: A Single Center's Real-world Experience
Panagiotis Drakos, MD, Georgios Tzavellas, MD, Apostolos Tassiopoulos, MD, Shang Loh, MD, George Koullias, MD, Angela A. Kokkosis, MD.
Stony Brook University Hospital, Stony Brook, NY, USA.
Objective(s): The purpose of this study is to demonstrate a single academic center's experience with transcarotid artery revascularization (TCAR) using the Silk Road flow reversal system as a safe and effective alternative to transfemoral carotid artery stenting (CAS).
Methods: 12 Patients with high-grade carotid artery stenosis (defined as ≥ 80% stenosis for asymptomatic and ≥60% for symptomatic patients) and other comorbidities such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), chronic kidney disease (CKD), end stage renal disease (ESRD), peripheral artery disease (PAD) and hostile neck due to previous ipsilateral CEA with restenosis, underwent TCAR. The primary outcomes were defined as death, stroke, myocardial infarction, device failure, procedural and access site complications. All patients were on aspirin, clopidogrel and a statin and continued this regimen after discharge. Follow up visit was scheduled within 1 month post operatively, to determine carotid stent patency using carotid duplex ultrasound, and to assess for any neurologic deficits.
Results: 12 patients (5 males and 7 females) with a mean carotid stenosis of 87.1% (60-95), mean duplex PSV of 489.6cm/s (278-805cm/s), mean duplex EDV of 130.3cm/s (42-314cm/s) mean age of 78.2 years (63-86) and a mean BMI of 28.9 kg/m2 (20-36.8) underwent TCAR. The comorbidities were as follows: CHF(4), COPD(2), CAD(7), CKD(3), ESRD(2), and PAD(2). There were no perioperative complications and the mean length of stay was 1.1 days. Eight out of the twelve patients completed their 1-month follow-up. All eight patients had patent carotid stents with no neurologic deficits.
Conclusions: TCAR is a novel, well-tolerated and successful carotid artery revascularization technique in this small cohort of patients with high-grade carotid artery stenosis and high-risk preoperative status. This method could be the safer alternative to CEA for patients with anatomic and physiologic risks without the added risk of perioperative stroke as compared to traditional transfemoral CAS.
Back to 2017 ePoster Competition