This study clear depicts the early outcomes in the roadster However, as with CEA, patients must be carefully selected for TCAR. It was good for the authors’ that our group was not included in this study or the technical success rate would not have been as high. Although we are very experienced endovascular interventionalists, including for transfemoral carotid artery stenting, two different members of our group could not advance wires through severely stenotic, calcified internal carotid lesions in two different patients on the same day; thus, conversion to good old CEA proved necessary in both cases. Granted, the patients might not have been “per protocol” patients. A factor that might be associated with a greater incidence of stroke, hematoma, local nerve injury, and, especially, dissection when performing TCARs is the use of TCAR for patients with thick, short necks. Advancing wires, catheters, and sheaths through the common carotid artery via a small lower neck incision in patients with a deep common carotid artery can be much more challenging than doing so percutaneously via the femoral artery. Although I applaud the authors’ efforts to show the safety of a relatively new technique, the novice should be careful to be sure to use TCARs “per protocol”—and avoid thick necks.
Reference link- https://www.jvascsurg.org/article/S0741-5214(20)32043-7/fulltext
