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International Young Surgeons Competition

IYSC05 - Outcomes of Carotid Stenting for Nonatherosclerotic Disease

Thursday, June 5, 2025
1:50 PM – 1:55 PM CT
Location: Morial CC, Second Floor, Room 224
Objectives: Carotid artery stenting (CAS) is a well-recognized treatment for atherosclerotic carotid artery disease, recent studies have demonstrated that transcarotid artery revascularization (TCAR) is associated with lower risks of stroke and death compared to transfemoral carotid artery stenting (tfCAS) in patients with atherosclerotic carotid stenosis. The comparative outcomes of these techniques in nonatherosclerotic carotid diseases – dissection, trauma, and fibromuscular dysplasia (FMD) – however remain underexplored. This study aims to evaluate and compare the outcomes of tfCAS and TCAR in nonatherosclerotic carotid disease.

Methods: Patients undergoing CAS for dissection, trauma, or FMD were identified in the Vascular Quality Initiative (VQI) between 2016-2024. Demographics, procedural characteristics, and postoperative outcomes were compared between the two groups. Primary outcomes included stroke, death, and major adverse cardiovascular events (MACE) defined as a composite of stroke/MI/death. Multivariate logistic regression was used to assess the differences in postoperative outcomes.

Results: Among 818 patients (tfCAS: n=590, TCAR: n=228), TCAR patients were older (66.79 vs 58.35, p< 0.001), had more hypertension (78.91% vs 64.2%, p< 0.001), and coronary artery disease (38.2% vs 25.8%, p< 0.001). Dissection was the most common etiology in both groups (TCAR: 78.5%, tfCAS: 79.5%), followed by trauma (TCAR: 8.8%, tfCAS: 8.8%) and FMD (TCAR: 12.7%, tfCAS: 9.7%). Intraoperatively, TCAR patients required slightly longer procedure times (75.5 mins vs 69 mins, p =0.016). When comparing outcomes by etiology, there was no significant differences in stroke (p=0.669) or MACE (p=0.101) between the groups, while mortality was more common in trauma patients (trauma 7.1%, Dissection 2.2%, FMD 1.2%, p=0.017). When analyzing by procedure type, TCAR had significantly lower rates of MACE (2.2% vs 6.4%, p=0.015) and death (0.4% vs 3.4%, p=0.017), but a non-significant stroke advantage (1.3% vs 3.1%, p=0.159). Multivariate analysis confirmed that TCAR was associated with a lower risk of MACE (OR 0.303, 95% CI 0.108–0.852, p=0.024), but not stroke or death (Table 1).

Conclusions: This study suggests that TCAR is associated with improved postoperative outcomes compared to tfCAS in patients with nonatherosclerotic carotid disease, notably in reducing MACE. These findings support the preferential use of TCAR in selected patients with non-atherosclerotic carotid artery disease.