Editor's Choice – Early and Late Outcomes after Transcarotid Revascularisation for Internal Carotid Artery Stenosis: A Systematic Review and Meta-Analysis

• Published in: European journal of vascular and endovascular surgery 2021-05, Vol.61 (5), p.725-738
• Main Authors: Galyfos, George C., Tsoutsas, Ioannis, Konstantopoulos, Theofanis, Galanopoulos, Georgios, Sigala, Frangiska, Filis, Konstantinos, Papavassiliou, Vassilios
• Format: Article
• Language: English
• Subjects: Angioplasty (Mesh); Carotid artery stenosis (Mesh); Repair (non-Mesh); Stenting (Mesh); Transcarotid (non-Mesh); Transcervical (non-Mesh)
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2021.01.039

Transcarotid/transcervical revascularisation (TCAR) is an alternative to carotid endarterectomy (CEA) and transfemoral carotid stenting (tfCAS). This review aimed to evaluate pooled data on patients undergoing TCAR. Medline, Embase, Scopus, and Cochrane Library databases were used. This systematic review was conducted under Systematic Reviews and Meta-Analysis guidelines. Eligible studies (published online up to September 2020) reported 30 day mortality and stroke/transient ischaemic attack (TIA) rates in patients undergoing TCAR. Data were pooled in a random effects model and weight of effect for each study was also reported. Quality of studies was evaluated according to Newcastle – Ottawa scale. Eighteen studies (three low, seven medium, and eight high quality) included 4 852 patients (4 867 TCAR procedures). The pooled 30 day mortality rate was 0.7% (n = 32) (95% confidence interval [CI] 0.5 – 1.0), 30 day stroke rate 1.4% (n = 62) (95% CI 1.0 – 1.7), and 30 day stroke/TIA rate 2.0% (n = 92) (95% CI 1.4 – 2.7). Pooled technical success was 97.6% (95% CI 95.9 – 98.8). The cranial nerve injury rate was 1.2% (95% CI 0.7 – 1.9) (n = 14; data from 10 studies) while the early myocardial infarction (MI) rate was 0.4% (95% CI 0.2 – 0.6) (n = 16; data from 17 studies). The haematoma/bleeding rate was 3.4% (95% CI 1.7 – 5.8) (n = 135; data from 10 studies), with one third of these cases needing drainage or intervention. Within a follow up of 3 – 40 months the restenosis rate was 4% (95% CI 0.1 – 13.1) (data from nine studies; n = 64/530 patients) and death/stroke rate 4.5% (95% CI 1.8 – 8.4) (data from five studies; n = 184/3 742 patients). Symptomatic patients had a higher risk of early stroke/TIA than asymptomatic patients (2.5% vs. 1.2%; odds ratio 1.99; 95% CI 1.01 – 3.92); p = .046; data from eight studies). TCAR is associated with promising early and late outcomes, with symptomatic patients having a higher risk of early cerebrovascular events. More prospective comparative studies are needed in order to verify TCAR as an established alternative treatment technique.