Intraoperative Fusion Imaging During Transcarotid Artery Revascularization

Abstract

BackgroundTranscarotid artery revascularization (TCAR) with reverse-flow neuroprotection has emerged as an alternative to transfemoral carotid artery stenting and carotid endarterectomy. However, it requires fluoroscopic guidance, exposing patient and surgeon to radiation. Although computed tomography (CT) fusion-guided EVAR has been demonstrated to significantly decrease this radiation risk, not much is known about similar outcomes for TCAR. The purpose of this study is to evaluate outcomes at a single institution utilizing CT fusion-guided imaging during TCAR compared to regional TCAR cases in the Vascular Quality Initiative (VQI) registry without CT fusion imaging.MethodsA retrospective analysis was conducted of data collected from all patients undergoing TCAR with CT fusion-guided imaging (TCAR-F) at our hospital (Figure) and TCAR patients within the VQI database. Primary outcomes included total operative time, dose area product, fluoroscopy time, contrast use, and flow-reversal time. Demographics and preoperative risk factors were also assessed in both groups. Continuous outcomes were compared using Welch’s t test. Categorical outcomes were compared using Fisher’s exact test.ResultsA total of 30 TCAR-F cases (January 2019 to May 2022) at our institution were compared against the regional VQI dataset (n = 2,535). TCAR-F cases had lower dose area product (5.67 Gy.cm2 vs 93.1 Gy.cm2; P < .0001), fluoroscopic time (8.07 minutes vs 16.4 minutes; P < .0001), and contrast use (13.49 mL vs 76.7 mL; P < .0001) as compared to regional averages of the same. TCAR-F cases had longer total operative time (117.3 minutes vs 80.9 minutes; P < .0001) and flow-reversal time (14.4 minutes vs 11.7 minutes; P = .025) than regional cases.Conclusions BackgroundTranscarotid artery revascularization (TCAR) with reverse-flow neuroprotection has emerged as an alternative to transfemoral carotid artery stenting and carotid endarterectomy. However, it requires fluoroscopic guidance, exposing patient and surgeon to radiation. Although computed tomography (CT) fusion-guided EVAR has been demonstrated to significantly decrease this radiation risk, not much is known about similar outcomes for TCAR. The purpose of this study is to evaluate outcomes at a single institution utilizing CT fusion-guided imaging during TCAR compared to regional TCAR cases in the Vascular Quality Initiative (VQI) registry without CT fusion imaging. Transcarotid artery revascularization (TCAR) with reverse-flow neuroprotection has emerged as an alternative to transfemoral carotid artery stenting and carotid endarterectomy. However, it requires fluoroscopic guidance, exposing patient and surgeon to radiation. Although computed tomography (CT) fusion-guided EVAR has been demonstrated to significantly decrease this radiation risk, not much is known about similar outcomes for TCAR. The purpose of this study is to evaluate outcomes at a single institution utilizing CT fusion-guided imaging during TCAR compared to regional TCAR cases in the Vascular Quality Initiative (VQI) registry without CT fusion imaging. MethodsA retrospective analysis was conducted of data collected from all patients undergoing TCAR with CT fusion-guided imaging (TCAR-F) at our hospital (Figure) and TCAR patients within the VQI database. Primary outcomes included total operative time, dose area product, fluoroscopy time, contrast use, and flow-reversal time. Demographics and preoperative risk factors were also assessed in both groups. Continuous outcomes were compared using Welch’s t test. Categorical outcomes were compared using Fisher’s exact test. A retrospective analysis was conducted of data collected from all patients undergoing TCAR with CT fusion-guided imaging (TCAR-F) at our hospital (Figure) and TCAR patients within the VQI database. Primary outcomes included total operative time, dose area product, fluoroscopy time, contrast use, and flow-reversal time. Demographics and preoperative risk factors were also assessed in both groups. Continuous outcomes were compared using Welch’s t test. Categorical outcomes were compared using Fisher’s exact test. ResultsA total of 30 TCAR-F cases (January 2019 to May 2022) at our institution were compared against the regional VQI dataset (n = 2,535). TCAR-F cases had lower dose area product (5.67 Gy.cm2 vs 93.1 Gy.cm2; P < .0001), fluoroscopic time (8.07 minutes vs 16.4 minutes; P < .0001), and contrast use (13.49 mL vs 76.7 mL; P < .0001) as compared to regional averages of the same. TCAR-F cases had longer total operative time (117.3 minutes vs 80.9 minutes; P < .0001) and flow-reversal time (14.4 minutes vs 11.7 minutes; P = .025) than regional cases. A total of 30 TCAR-F cases (January 2019 to May 2022) at our institution were compared against the regional VQI dataset (n = 2,535). TCAR-F cases had lower dose area product (5.67 Gy.cm2 vs 93.1 Gy.cm2; P < .0001), fluoroscopic time (8.07 minutes vs 16.4 minutes; P < .0001), and contrast use (13.49 mL vs 76.7 mL; P < .0001) as compared to regional averages of the same. TCAR-F cases had longer total operative time (117.3 minutes vs 80.9 minutes; P < .0001) and flow-reversal time (14.4 minutes vs 11.7 minutes; P = .025) than regional cases. Conclusions