Outcomes of Transcarotid Artery Revascularization Stratified by Institutional Designation: Academic Versus Community Hospitals.

Background: The extent of practice setting's influence on transcarotid artery revascularization (TCAR) outcomes is not yet established. This study seeks to assess and compare TCAR outcomes in academic and community-based healthcare settings.

Methods: Retrospective review of prospectively maintained, systemwide TCAR databases from 2 institutions was performed between 2015 and 2022.

Effect of Perioperative Stroke on Survival After Carotid Intervention.

Objectives: Perioperative stroke is the most dreaded complication of carotid artery interventions and can severely affect patients' quality of life. This study evaluated the impact of this event on mortality for patients undergoing interventional treatment of carotid artery stenosis with three different modalities.

Methods: Patients undergoing carotid revascularization at participating Memorial Hermann Health System facilities were captured from 2003-2022.

Gore cTAG sleeve-associated maldeployment for traumatic aortic injury with aberrant right subclavian artery.

A 30-year-old woman presented following a motor vehicle collision with a grade III blunt thoracic aortic injury and an aberrant right subclavian artery. Using intraoperative ultrasound and diagnostic subtraction angiography, we deployed an aortic endograft (cTAG; W.L.

Propensity-score-matched analysis of dual antiplatelet treatment and alternative antiplatelet regimens after transcarotid revascularizations.

Objective: Dual antiplatelet therapy (DAPT) continues to be the preferred medication regimen after the placement of a carotid stent using the transcarotid revascularization (TCAR) technique despite a dearth of quality data. Therefore, this investigation was performed to define the risks associated with antiplatelet choice.

Methods: We queried all patients who underwent TCAR captured by the Vascular Quality Initiative from September 2016 to June 2022, to determine the association between antiplatelet choice and outcomes.

Spontaneous celiac artery dissection treated by balloon angioplasty.

Spontaneous isolated celiac artery dissection (SICAD) is a rare condition, defined as dissection of the celiac artery without aortic involvement. Because of its low prevalence, most studies have been limited to case reports and case series. We have described the case of a 44-year-old woman who had presented with symptomatic SICAD that had resulted in compromised flow to the hepatic arteries and was successfully treated with balloon angioplasty.

Transcarotid Revascularization Timing and Early Postoperative Outcomes in Symptomatic Patients.

Objective: Carotid endarterectomy (CEA) performed several days after onset of symptoms has been shown to be optimal in preventing procedure-related stroke. Transcarotid artery revascularization (TCAR) is an alternative hybrid procedure to treat high-risk for CEA patients. In this investigation, our aim is to determine the effect of timing of TCAR in symptomatic patients.

Fate of Hemodialysis Patients Undergoing Transcarotid Revascularization.

Introduction: Carotid revascularization in patients with end-stage renal disease (ESRD) continues to be a controversial topic, as life expectancy is poor, thus, preventing the recouperation of cumulative stroke-risk reduction in the postoperative period. We performed this primarily descriptive analysis of the results of transcarotid revascularization (TCAR) in renal failure patients.

Methods: A retrospective review of two independent carotid revascularization databases maintained at two large health systems were performed to capture all consecutive TCAR procedures.

Predictors of 30-Day Stroke and Death After Transcarotid Revascularization.

Introduction: Much of the previous robust analyses of the results associated with transcarotid revascularization (TCAR) derives from industry-sponsored trials or the Vascular Quality Initiative (VQI). This investigation was performed to identify preoperative predictors of 30-day stroke and death using institutional databases.

Methods: A retrospective analysis was performed of carotid revascularization databases created at two high-volume TCAR centers and maintained independently of the VQI carotid module between December 2015 and December 2021.

Adverse events are not increased with trainee participation in transcarotid revascularization.

Objective: To determine whether a vascular surgery trainee's participation in transcarotid revascularization (TCAR), a new technology, affects patient safety and outcomes.

Design: Retrospective, institutional review of our carotid database was performed. Patients who underwent TCAR were stratified based on whether a vascular trainee was present during the procedure.

Dual Antiplatelet Alternatives are Associated With Increased Stroke and Death After Transcarotid Revascularization.

Objective: To define the risks associated with the replacement of dual antiplatelets for alternate medication regimens.

Background: Patients undergoing transcarotid artery revascularization (TCAR) for atherosclerotic disease in the Vascular Quality Initiative database from September 2016 to June 2022 were included. In all, 29,802 TCAR procedures were captured between 2016 and 2022, consisting of 24,651 (82.

Fixed compared to mobile imaging arms for transcarotid artery revascularization.

Objective: Transcarotid artery revascularization (TCAR) is a new surgical option for carotid artery stenosis. While this procedure is optimally performed in hybrid operating rooms (OR), it is currently unclear whether it could be safely performed using portable, C-arm fluoroscopy with equivalent results. The aim of this study is to determine whether there are differences in intraoperative and perioperative outcomes stratified by imaging modality.

Transcarotid Revascularization Results in Patients Over 70 Years of Age.

Objective: Carotid endarterectomy is associated with fewer procedure-related strokes than transfemoral carotid artery stenting in older populations, based on the results from previous quality randomized controlled studies. Transcarotid artery revascularization (TCAR) is a hybrid procedure completed in the setting of cerebral flow reversal to deploy a stent, making it an appealing choice for older patients. This study was completed to elicit any age-related differences in outcomes after undergoing TCAR in patients 70 years of age and older.

Transcarotid Revascularization Associated Extended Reverse Flow Duration is Not a Harbinger of Poor Perioperative Outcomes.

Background: Transcarotid revascularization (TCAR) is a carotid stenting technique in which an external shunt between the common carotid artery and femoral vein is created to induce cerebral flow reversal as protection against procedure-related plaque embolism. We completed this analysis to determine if prolonged cerebral flow reversal was associated with adverse perioperative outcomes.

Methods: A retrospective review of a combined carotid revascularization database separately maintained at 2 high-volume TCAR health systems was completed.

Safety of Transcarotid Revascularization in Patients with a Contraindication to Dual Antiplatelets.

Objective: Current carotid artery stenting practice guidelines recommend dual antiplatelets to reduce major adverse cardiovascular events during and after transcarotid revascularization (TCAR). However, some patients are poor candidates for this regimen, due to preexisting need for anticoagulation, allergies, and/or risk of major bleeding. Therefore, this investigation was performed to review outcomes associated with patients undergoing TCAR while on alternative medication regimens to determine safety and efficacy.

Transcarotid revascularization in obese patients.

Objective: Transcarotid revascularization (TCAR) is a minimally invasive hybrid surgical carotid stenting technique which utilizes cerebral flow reversal as embolic protection during carotid lesion manipulation. This investigation was performed to define the perioperative risks associated with this operation in the obese patient.

Methods: A retrospective review of tandem carotid revascularization databases maintained at two high-volume health systems was performed to capture all TCARs performed between 2015 and 2022.

Prediction of postprocedural filter debris after transcarotid revascularization.

Objective: Transcarotid revascularization (TCAR) is a technique in which cerebral flow reversal is utilized as embolic protection during carotid stenting. The presence, or absence, of filter debris created during TCAR could potentially be a surrogate to characterize carotid lesions at high risk for embolization and, therefore, explored in this investigation.

Methods: A retrospective review of TCARs performed within the Indiana University and Memorial Hermann (McGovern Medical School at UTHealth) Health Systems to capture demographics and preoperative variables.

Results associated with the health system-wide adoption of transcarotid revascularization.

Background: In the present report, we have detailed the results derived from the adoption of transcarotid artery revascularization (TCAR) at a large health system based in the United States.

Methods: A retrospective review was performed of a prospectively maintained database capturing all carotid stents deployed using the ENROUTE neuroprotection device (Silk Road Medical, Sunnyvale, CA) and cerebral flow reversal. The demographics, intraoperative findings, and postoperative results were tabulated and reported.

Transcarotid artery revascularization is safe in necks with anatomy hostile for carotid endarterectomy.

Objective: The outcomes associated with transcarotid revascularization (TCAR) have proved to be noninferior to the historical results established for carotid endarterectomy (CEA). Therefore, TCAR has been increasingly offered to patients with neck anatomy hostile for traditional CEA. The present investigation was completed to evaluate whether a difference exists for patients undergoing TCAR in de novo anatomy with unviolated surgical planes compared with those undergoing TCAR in necks with hostile anatomy.

Institutional Experiences with Transfemoral Compared to Transcarotid Stenting.

Background: Transcarotid artery revascularization (TCAR) is a new surgical technique that is gaining popularity over the transfemoral method (TF-CAS) as the preferred strategy to deliver a carotid stent. This investigation was performed to evaluate the real-world perioperative and long-term outcomes of both techniques at the health system level.

Methods: A retrospective review of prospectively maintained carotid revascularization databases were performed at 2 high-volume TCAR centers in the United States to extract consecutive TF-CAS and TCAR procedures.

Dual culprit for a swollen leg: Femoral vein compression caused by lymphadenopathy and a synovial cyst.

A young man had presented to the clinic with unilateral leg swelling with concerns for deep vein thrombosis. Imaging studies revealed external compression of the left common femoral vein due to enlarged lymph nodes and a cystic structure in the left groin. He underwent surgical exploration with resection of multiple compressive lymph nodes but continued to remain symptomatic.

Endovascular repair of traumatic aortic injury in a pediatric patient.

We present the case of a 14-year-old girl who sustained a traumatic aortic injury (TAI) after a motor vehicle collision. Due to the severity of her associated injuries, she was not a candidate for open aortic repair. Available options for endovascular repair were very limited due to the small aortic diameter (14 mm).

Blunt traumatic aortic injury: initial experience with endovascular repair.

Objectives: Endovascular treatment of traumatic aortic injury (TAI) is an alternative to open repair (OR) in patients with blunt trauma. We report our initial experience after integration of endovascular repair using thoracic devices.

Methods: A retrospective review of a prospectively collected institutional trauma registry was performed.

Analysis of motor and somatosensory evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair.

Objectives: Use of motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP) monitoring during thoracic and thoracoabdominal aortic surgery is controversial. This study evaluated the intraoperative use of SSEP and MEP during thoracoabdominal repair and assessed their role in decreasing the risk of spinal cord ischemia and paralysis.

Methods: We conducted paired SSEP and MEP monitoring to assess agreement between the methods and their ability to predict neurologic outcome in 233 patients.