Clinical Report: Comparison of Perioperative and Short-Term Outcomes in Carotid Revascularization

Overview

This study compares the perioperative and six-month outcomes of Transcervical Carotid Artery Stenting (TC-CAS), Transfemoral Carotid Artery Stenting (TF-CAS), and Carotid Endarterectomy (CEA) in patients with carotid artery stenosis. Results indicate comparable perioperative stroke rates across all techniques, with TC-CAS showing no stroke or TIA events at six months.

Background

Carotid artery stenosis is a significant contributor to ischemic stroke, necessitating effective revascularization strategies. CEA has long been the standard treatment; however, minimally invasive alternatives like CAS are increasingly utilized, especially in high-risk patients. Understanding the comparative outcomes of these techniques is crucial for optimizing patient care and reducing stroke risk.

Data Highlights

Key Findings

• Perioperative stroke rates were low and comparable: TF-CAS 2.5%, TC-CAS 2.0%, CEA 1.1% (P = 0.802).
• Cranial nerve injury was observed exclusively in the CEA group.
• Six-month restenosis rates showed no significant difference: TF-CAS 3.7%, TC-CAS 2.0%, CEA 4.5% (P = 0.752).
• No stroke or TIA events were recorded in the TC-CAS group during the six-month follow-up.
• Hospital costs were significantly lower for CEA compared to TF-CAS and TC-CAS (P < 0.001).
• TC-CAS is a promising alternative for patients with high-risk anatomy.

Clinical Implications

The findings suggest that TC-CAS is a safe and effective option for carotid revascularization, particularly in patients with challenging anatomical features. Clinicians should consider TC-CAS as a viable alternative to TF-CAS and CEA, especially for high-risk patients, while also being mindful of the lower costs associated with CEA.

Conclusion

TC-CAS demonstrates favorable perioperative safety and short-term outcomes compared to TF-CAS and CEA. Further long-term studies are needed to validate these findings and assess the sustained efficacy of TC-CAS.

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2. Clinical Research in Cardiology, 2019 -- SAPPHIRE Criteria, Myocardial Infarction History, and Diabetes as Predictors of Negative Outcomes After Carotid Endarterectomy Compared to Stenting
3. Clinical Research in Cardiology, 2020 -- Collateral Arterial Anatomy as a Predictor of Intra-operative Somatosensory Evoked Potential Variations in Carotid Endarterectomy Patients: A Prospective Cohort Analysis
4. Clinical Practice Guidelines, 2023 -- ESVS 2023 Carotid Guidelines
5. ScienceDirect, 2025 -- Comparative Safety and Efficacy of Transcarotid Artery Revascularization Versus Transfemoral Carotid Artery Stenting: A Systematic Review and Meta-Analysis
6. Intraoperative Functional Imaging Following Extracranial Carotid Endarterectomy to Identify Cerebral Hyperperfusion Syndrome
7. ESVS 2023 Carotid Guidelines
8. Comparative Safety and Efficacy of Transcarotid Artery Revascularization Versus Transfemoral Carotid Artery Stenting: A Systematic Review and Meta-Analysis - ScienceDirect
9. Stroke, Death, and MI After Transcarotid Artery Revascularization vs Carotid Endarterectomy