The study states that the Transcarotid artery revascularization (TCAR) with flow reversal provides a superior method of embolic protection compared with transfemoral carotid artery stenting (tfCAS) with distal embolic protection. Flow reversal or flow arrest systems with proximal endovascular balloon occlusion can also be used through the transfemoral approach; however, their outcomes compared with TCAR with flow reversal and tfCAS with distal embolic protection are poorly described. We performed a retrospective review of all patients undergoing tfCAS with proximal balloon occlusion, tfCAS with distal embolic protection, and TCAR with flow reversal in the Society for Vascular Surgery Vascular Quality Initiative from March 2005 to May 2019. We assessed in-hospital outcomes of propensity score-matched cohorts of patients using tfCAS with proximal balloon occlusion as the comparison cohort. The primary outcome was stroke or death.
The Results Of the 24,232 patients undergoing CAS, 561 (2.3%) were performed by tfCAS with proximal balloon occlusion, 18,126 (74%) by tfCAS with distal embolic protection, and 5545 (22.9%) bu TCAR with flow reversal. After matching, 464 pairs of patients undergoing tfCAS with proximal balloon occlusion and tfCAS with distal embolic protection were identified. There were no differences in stroke or death (proximal balloon 3.2% vs distal embolic protection 3.7%; relative risk.
Reference link- https://www.jvascsurg.org/article/S0741-5214(20)31435-X/fulltext
