This study states that the Transfemoral carotid artery stenting (TFCAS) has higher combined stroke and death rates in elderly patients compared with carotid endarterectomy (CEA). However, transcarotid artery revascularization (TCAR) may have similar outcomes to CEA. This study characterized annual trends in TCAR and compared their outcomes with CEA and TFCAS, focusing on octogenarians. We included all patients with carotid artery stenosis and no prior stenting or endarterectomy who underwent TCAR, CEA, or TFCAS in the Vascular Quality Initiative from September 2016 (TCAR commercially available) to December 2019. We categorized patients into decades: 60s (60-69 years), 70s (70-79 years), and 80s (80-90 years). Outcomes included in-hospital stroke, death within 30 days, a composite stroke/death outcome, and any postoperative neurologic events (includes transient ischemic attacks). Multivariable logistic regressions compared each outcome within every decade category after adjusting for patient demographics, clinical factors, symptoms, urgency, hospital CEA volume, and clustering. We identified 55,828 patients with carotid artery stenosis (35% in their 60s, 44% in their 70s, and 21% in their 80s); half (51%) were symptomatic, and the majority of procedures.
Reference link- https://www.jvascsurg.org/article/S0741-5214(20)31440-3/fulltext
