Association of Transcarotid Artery Revascularization vs Transfemoral Carotid Artery Stenting With Stroke or Death Among Patients With Carotid Artery Stenosis

Abstract

Prospectively collected data from the Vascular Quality Initiative Transcarotid Artery Surveillance Project and Carotid Stent Registry between September 2016 and April 2019. Of 3286 matched pairs of patients who underwent transcarotid artery revascularization (TCAR) or transfemoral carotid artery stenting (TF-CAS), TCAR was associated with a significantly lower risk of in-hospital stroke or death (1.6% vs 3.1%), stroke (1.3% vs 2.4%), and death (0.4% vs 1.0%; P < .05). There were no differences in the risk of perioperative myocardial infarction (0.2% vs 0.3%). At 1 year, TCAR was associated with a lower risk of ipsilateral stroke or death than TF-CAS (5.1% vs 9.6%; P < .001). TCAR was associated with higher risk of access site complications resulting in interventional treatment (1.3% vs 0.8%; P = .04), whereas TF-CAS was associated with significantly more irradiation and contrast material. TCAR was associated with a significantly lower risk of stroke or death than TF-CAS.