Safety and Efficacy of Spontaneous Carotid Artery Dissection Management with Transfemoral Carotid Artery Stenting and Transcarotid Artery Revascularization: A Multi-Institutional Study.
Academic Article
Overview
abstract
BACKGROUND: Carotid artery dissection (CD) could lead to stroke, particularly in younger patients. Most studies assessing the safety of carotid artery stenting have excluded patients with dissections. We aim to fill that knowledge gap by evaluating and comparing the outcomes of transfemoral carotid artery stenting (TFCAS) and transcarotid artery revascularization (TCAR) in the management of spontaneous CD using a national database. METHODS: This is a retrospective analysis of all patients who underwent either TFCAS or TCAR for spontaneous carotid dissection in the Vascular Quality Initiative database (2016-2024). The primary outcomes were 30-day mortality and in-hospital major adverse cardiovascular event (MACE), including stroke, death, and myocardial infarction. Multivariate logistic regression models were employed to adjust for potential confounders. RESULTS: There were 458 patients treated with TFCAS (310; 67.9%) or TCAR (148; 32.1%) for CD. TCAR patients were older with more medical comorbidities, while TFCAS patients were more likely to be symptomatic. Two-stent usage was similar between the two groups (20.3% TCAR vs. 26.3% TFCAS; P = 0.08). In all carotid artery stenting cases, 30-day mortality was 2.4%, with 1.7% in-hospital deaths, 2% strokes, and 0.7% myocardial infarctions. Stroke/death occurred in 3.7%, MACE in 4.4%, access site complications in 4%, and technical failure was rare at 0.2%. TCAR was associated with lower 30-day mortality (1.2% vs. 2.9%), stroke (0.7% vs. 2.7%), MACE (2% vs. 5.5%), technical failure (0% vs. 0.3%), and access site complications (2% vs. 4.8%) than TFCAS. However, these differences were not statistically significant (P > 0.05). CONCLUSION: In this multi-institutional national study, both procedures showed acceptable stroke and death rates. Although not statistically significant, TCAR was associated with better technical success and periprocedural outcomes in CD management.
