TCAR in Symptomatic Carotid Stenosis: A Systematic Review

Abstract

INTRODUCTION Carotid endarterectomy is currently the gold standard treatment option for significant symptomatic carotid stenosis. Carotid artery stenting may be an alternative in selected patients, although with inferior results when compared with its open counterpart. TCAR emerged as an alternative treatment option, with promising results. This study aims to systematically review current evidence of the safety of TCAR in patients with symptomatic carotid artery stenosis. EVIDENCE ACQUISITION 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. EVIDENCE SYNTHESIS 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. Post-operative 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%. CONCLUSION 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.