Transcarotid artery revascularization in symptomatic carotid stenosis: a systematic review

Carotid endarterectomy is currently the gold standard treatment option for significant symptomatic carotid stenosis. Carotid artery stenting can be an alternative in selected patients, although with inferior results when compared with its open counterpart. Transcarotid artery revascularization (TCAR) emerged as a new option, with promising results. This study aims to systematically review current evidence of the safety of TCAR in patients with symptomatic carotid artery stenosis. A systematic review of the literature was performed, according to PRISMA guidelines. Literature search was performed on the PubMed and Web of Science databases, which returned 178 studies. Eleven studies were selected. Data were extracted using predefined forms. A total of 28326 symptomatic patients undergoing TCAR were included for analysis. Reported TIA/stroke rates after TCAR ranged between 2.3-3.3% in-hospital and 1.2-4.3% at 30-days. Similarly, in-hospital post-operative mortality was reported in 0.5-0.7% of the cases, and 1-4.9% at 30 days. After 1 year, TIA/Stroke and death rates ranged between 3.5-3.7% and 2.5-13%, respectively. Postoperative cardiovascular events were observed in up to 2.9% of the patients among the included studies. Cranial nerve injuries were reported in up to 0.7% of the cases, while surgical and vascular access complications ranged between 1.2-6.1%. TCAR has shown promising results for significant symptomatic carotid stenosis treatment, and may be a relevant alternative to carotid endarterectomy, especially in high-risk patients. Further studies are required to assess the effectiveness of TCAR and its comparability with carotid endarterectomy.