Comparative Safety and Efficacy of Transcarotid Artery Revascularization (TCAR) Versus Transfemoral Carotid Artery Stenting (TFCAS): A Systematic Review and Meta-analysis.
Atef A Hassan, Sherif Alaa Sharaby, Elsayed Elesheshtawy Elbosraty, Mohamed Ibrahim Abdo, Ahmed Attia Shaban, Fouad Mohammed Awad, Reda Othman Abbas, Mohamed A Khalafallah, Mohamed Ibrahim Hammoda, Haytham Yousef Aboelsaad
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Abstract
Background: Carotid artery stenosis is a significant cause of ischemic stroke. Transcarotid artery revascularization (TCAR), a newer technique utilizing dynamic flow reversal, has emerged as a potentially safer alternative to transfemoral carotid artery stenting (TFCAS). This systematic review and meta-analysis aimed to compare TCAR and TFCAS in patients undergoing carotid revascularization.
Methods: We searched PubMed, Cochrane CENTRAL, Scopus, and Web of Science through June 2025 for comparative studies evaluating TCAR vs TFCAS. Primary outcomes included 30-day and in-hospital mortality, stroke, and composite stroke/death. Secondary outcomes assessed myocardial infarction (MI), transient ischemic attack (TIA), procedural times, and periprocedural complications. Risk ratios (RRs) and mean differences (MDs) were pooled using random-effects models.
Results: Thirteen studies involving 142,032 patients were included in the analysis. TCAR significantly reduced 30-day mortality (RR 0.45; p<0.001), in-hospital mortality (RR 0.45; p<0.001), 30-day stroke (RR 0.66; p<0.001), and composite 30-day stroke/death (RR 0.57; p<0.001). TIA (RR 0.72; p<0.001) and stroke/TIA (RR 0.66; p<0.001) were also lower with TCAR. MI rates were similar overall, though asymptomatic patients had a higher 30-day MI risk with TCAR. TCAR reduced reperfusion injury (RR 0.38; p<0.001) and hospital stay length (RR 0.76; p<0.001), but had slightly longer operative times. Long-term data from two large cohorts confirmed TCAR's durable stroke risk reduction up to 3 years.
Conclusion: This meta-analysis of current observational data demonstrates that TCAR is associated with superior perioperative outcomes compared to TFCAS, with significantly lower rates of stroke and death. These findings support TCAR as a preferred endovascular treatment for eligible patients with carotid artery stenosis.
背景：颈动脉狭窄是缺血性脑卒中的重要原因。经颈动脉血管重建术（TCAR）是一种利用动态血流逆转的新技术，已成为一种比经股颈动脉支架置入术（TFCAS）更安全的选择。本系统综述和荟萃分析旨在比较颈动脉血运重建术患者的TCAR和TFCAS。方法：我们检索PubMed、Cochrane CENTRAL、Scopus和Web of Science，检索到2025年6月的评价TCAR与TFCAS的比较研究。主要结局包括30天和住院死亡率、卒中和卒中/死亡复合。次要结果评估心肌梗死（MI）、短暂性脑缺血发作（TIA）、手术时间和手术期并发症。采用随机效应模型合并风险比（rr）和平均差异（md）。结果：13项研究共纳入142032例患者。结论：对当前观察数据的荟萃分析表明，与TFCAS相比，TCAR与更好的围手术期预后相关，卒中和死亡率显著降低。这些发现支持TCAR作为符合条件的颈动脉狭窄患者首选的血管内治疗方法。
期刊介绍：
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence
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