Abstract 12941: In-Hospital Outcomes Among Diabetics Undergoing Transcarotid Artery Revascularization for Carotid Artery Stenosis

Abstract

Introduction: Transcarotid artery revascularization (TCAR) is a novel procedure to intervene on clinically significant carotid artery stenosis. Periprocedural rates of stroke have remained exceedingly low in clinical trials (<1.5%). Diabetics are known to have elevated risk of periprocedural adverse events with both carotid endarterectomy and carotid artery stenting. TCAR may offer lower periprocedural rates of cerebrovascular accident given its novel flow reversal technique. However, outcomes among diabetics undergoing TCAR remain unknown. We sought to determine periprocedural cardiovascular and cerebrovascular events (MACCE) among diabetics undergoing the TCAR procedure in a large national database. Methods: The Vascular Quality Initiative database was queried for all TCAR procedures performed from January 2012 to March 2021. Baseline demographic information as well as periprocedural outcomes were obtained. In cases in which a patient had multiple procedures, only the most recent procedure was evaluated. Results: A total of 19,341 patients (median age 74 (IQR 67-80), 63.7% male and 90.3% white) underwent the TCAR procedure. Of this n=7,427 (38.4%) were diabetics. Compared to non-diabetics, the diabetic cohort had a higher risk of stroke (1.7% vs 1.3%, p=.02), transient ischemic attack (0.7% vs 0.4% p =.027), and myocardial infarction (0.7% vs 0.5% p=.064). Death remained a rare outcome, with diabetics having 0.5% periprocedural mortality vs 0.4% among non-diabetics (p=.096). Conclusions: TCAR is a safe revascularization method for significant carotid artery stenosis with an elevated risk of periprocedural MACCE in diabetics compared to non-diabetics. Further study is needed to define optimal patient selection for this novel and less-invasive management strategy for carotid artery disease.