Physicians' Preference for Carotid Revascularization Impacts Postoperative Stroke and Death Outcomes.

Document Type

Article

Publication Date

12-27-2024

Publication Title

Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter

Abstract

BACKGROUND: TransCarotid artery revascularization (TCAR) is a safe minimally invasive option for patients with carotid artery stenosis who are not appropriate candidates for carotid endarterectomy (CEA). Many physicians have not yet adopted this technique in the management of carotid artery stenosis. The aim of this study is to explore overall outcomes of carotid revascularization based on physicians' practices in the Vascular Quality Initiative (VQI).

METHODS: Individual physicians participating in both the carotid artery stenting (CAS) and carotid endarterectomy (CEA) modules in VQI were categorized as performing CEA and TCAR, CEA and transfemoral carotid artery stenting (TfCAS) or all 3 procedures (CEA, TCAR and TFCAS). Physicians performing CEA only or TCAR/TfCAS only were excluded. In-hospital and one-year outcomes were compared between the 3 groups using univariable and multivariable analysis.

RESULTS: A total of 104,925 carotid revascularization procedures performed by 1,433 physicians were included. Most physicians performed CEA and TCAR (n=714, 49.8%), while 35.1% (n=503) performed all 3 procedures and 15.1% (n=216) performed CEA and TfCAS only. Physicians performing CEA and TfCAS had higher overall stroke/death rates after carotid procedures (2.2%) compared to those performing CEA and TCAR (1.4%) or those performing all 3 procedures (1.6%, p

Volume

S0741-5214

Issue

24

First Page

02321-8

DOI

10.1016/j.jvs.2024.12.125

ISSN

1097-6809

PubMed ID

39733781

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