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Lynchburg Journal of Medical Science

Specialty

Physician Assistant Education

Abstract

This paper aims to evaluate the role of transcarotid artery revascularization (TCAR) in the management of carotid artery stenosis. A comprehensive literature search was conducted using PubMed to identify the role and current outcomes of TCAR compared to carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS). Carotid artery stenosis accounts for a significant portion of ischemic strokes. The global burden of stroke includes permanent disability and death. Medical and surgical interventions following ischemic stroke are aimed at reducing the future incidence of ischemic stroke based on the underlying etiology. Symptomatic carotid artery stenosis management includes optimal medical management and carotid artery revascularization with CEA or carotid artery stenting (CAS). Historically, CAS has been performed from the transfemoral route, requiring manipulation of the aortic arch, resulting in an increased risk of periprocedural stroke compared to CEA. As a result, CEA has been considered the gold standard for treating carotid artery stenosis. TCAR offers an alternative approach to carotid artery revascularization. The TCAR procedure utilizes a neck incision to access the common carotid artery, avoiding the aortic arch, and a flow reversal system for neuroprotection. This article aims to evaluate the role and outcomes of TCAR in carotid artery revascularization, primarily in high-risk symptomatic patients. Further research is needed to determine the role of TCAR in managing both standard-risk and high-risk patients with asymptomatic and symptomatic carotid artery stenosis, as well as to assess the long-term outcomes of TCAR.

Keywords: carotid artery stenosis, carotid endarterectomy, transfemoral carotid artery stenting, transcarotid artery revascularization, ischemic stroke.

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