Role of Transcarotid Artery Revascularization (TCAR) as a Carotid Revascularization Option

Abstract

Transcarotid artery revascularization (TCAR) is a hybrid carotid revascularization procedure in which carotid stenting is accomplished by making an incision at the base of the neck & surgically exposing the common carotid artery. The evidence base for TCAR safety & efficacy comes from PROOF, ROADSTER, & ROADSTER 2 studies. The Society for Vascular Surgery guidelines for the treatment of carotid artery disease (2022) opine TCAR to be at least equivalent to Carotid Endarterectomy (CEA) in terms of safety & efficacy, with some potential improvements. In comparison with Transfemoral Carotid Artery Stenting (TF-CAS), the overall data demonstrates better outcomes with TCAR. In high-risk subjects like elderly more symptomatic patients with higher concurrent medical comorbidities, TCAR in fact appears to be preferable to both CEA & TF-CAS. Whereas this technique appears safe in the short-term, long-term vessel patency requires prospective follow-up studies.