Ezra Y Koh, Hanaa Dakour-Aridi, Mackenzie Madison, Arash Keyhani, Kourosh Keyhani, Raghu L Motaganahalli, Andres Fajardo, S Keisin Wang
{"title":"Comparison of Carotid Endarterectomy and Transcarotid Artery Revascularization in High Cervical Lesions.","authors":"Ezra Y Koh, Hanaa Dakour-Aridi, Mackenzie Madison, Arash Keyhani, Kourosh Keyhani, Raghu L Motaganahalli, Andres Fajardo, S Keisin Wang","doi":"10.1016/j.avsg.2025.09.031","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>High cervical carotid lesions increase intraoperative complexity in carotid endarterectomy (CEA) due to the challenge in obtaining a clean distal clamp site. For these cases, transcarotid artery revascularization (TCAR) may offer an alternative. Our aim was to compare outcomes of CEA and TCAR in patients with high cervical lesions.</p><p><strong>Methods: </strong>Demographics and outcomes of CEA and TCAR procedures were retrospectively captured at two high-volume institutions between 2003 and 2023. Patients with high cervical lesions, defined as target clamp sites above the C2 vertebra, were included. Patients were dichotomized according to surgical procedure. Univariate analysis was performed comparing baseline characteristics and outcomes in both groups at an α < 0.05.</p><p><strong>Results: </strong>2,250 patients were reviewed, of which 106 lesions (5%) were classified as above C2, of which 73 (69%) underwent TCAR and 33 (31%) underwent CEA. TCAR patients were more likely symptomatic, whereas CEA patients were more likely to have coronary artery disease. Perioperative (30-day) morbidity was similar (ipsilateral stroke was 2.7% vs. 6.1%, p=0.406, myocardial infarction was 1.4% vs. 0%, p=0.499, cranial nerve injury was 1.4% vs. 6.1%, p=0.406, and mortality was 1.4% vs. 0%, p=0.499). Operative time and estimated blood loss were higher with CEA (72.9 ± 31.8 minutes vs. 132.5 ± 53.2 minutes, p <0.001, and 47.1 ± 57.3 mL vs. 214.2 ± 285.7 mL, p < 0.001).</p><p><strong>Conclusion: </strong>This retrospective study demonstrates similar outcomes between CEA and TCAR. However, TCAR was associated with a shorter operative time, suggesting that this may be an advantageous approach.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.avsg.2025.09.031","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
Abstract
Background: High cervical carotid lesions increase intraoperative complexity in carotid endarterectomy (CEA) due to the challenge in obtaining a clean distal clamp site. For these cases, transcarotid artery revascularization (TCAR) may offer an alternative. Our aim was to compare outcomes of CEA and TCAR in patients with high cervical lesions.
Methods: Demographics and outcomes of CEA and TCAR procedures were retrospectively captured at two high-volume institutions between 2003 and 2023. Patients with high cervical lesions, defined as target clamp sites above the C2 vertebra, were included. Patients were dichotomized according to surgical procedure. Univariate analysis was performed comparing baseline characteristics and outcomes in both groups at an α < 0.05.
Results: 2,250 patients were reviewed, of which 106 lesions (5%) were classified as above C2, of which 73 (69%) underwent TCAR and 33 (31%) underwent CEA. TCAR patients were more likely symptomatic, whereas CEA patients were more likely to have coronary artery disease. Perioperative (30-day) morbidity was similar (ipsilateral stroke was 2.7% vs. 6.1%, p=0.406, myocardial infarction was 1.4% vs. 0%, p=0.499, cranial nerve injury was 1.4% vs. 6.1%, p=0.406, and mortality was 1.4% vs. 0%, p=0.499). Operative time and estimated blood loss were higher with CEA (72.9 ± 31.8 minutes vs. 132.5 ± 53.2 minutes, p <0.001, and 47.1 ± 57.3 mL vs. 214.2 ± 285.7 mL, p < 0.001).
Conclusion: This retrospective study demonstrates similar outcomes between CEA and TCAR. However, TCAR was associated with a shorter operative time, suggesting that this may be an advantageous approach.
背景：颈动脉高病变增加了颈动脉内膜切除术（CEA）的术中复杂性，因为很难获得一个干净的远端钳位。对于这些病例，经颈动脉重建术（TCAR）可能是另一种选择。我们的目的是比较CEA和TCAR在宫颈高度病变患者中的疗效。方法：回顾性收集2003年至2023年在两家高容量机构进行CEA和TCAR手术的人口统计学和结果。包括颈椎高度病变的患者，定义为C2椎体以上的目标钳位。根据手术方式对患者进行分类。采用单因素分析比较两组患者的基线特征和结局，α < 0.05。结果：共回顾2250例患者，其中C2级以上病变106例（5%），其中TCAR 73例（69%），CEA 33例（31%）。TCAR患者更有可能出现症状，而CEA患者更有可能出现冠状动脉疾病。围手术期（30天）发病率相似（同侧卒中为2.7%比6.1%,p=0.406，心肌梗死为1.4%比0%，p=0.499，颅神经损伤为1.4%比6.1%,p=0.406，死亡率为1.4%比0%，p=0.499）。CEA组的手术时间和预估失血量均高于TCAR组（72.9±31.8 min vs. 132.5±53.2 min）。结论：本回顾性研究显示CEA组与TCAR组的结果相似。然而，TCAR与较短的手术时间相关，这表明这可能是一种有利的方法。
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
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
