Hospital availability of TCAR associated with an improvement in overall outcomes for carotid revascularization

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Silk Road Medical has announced positive results from a comparative-effectiveness study involving transcarotid artery revascularization (TCAR) that was published in JAMA Network Open.

The study found the availability of TCAR at a hospital was associated with a significant decrease in the likelihood of major adverse cardiovascular events (MACE), a composite of in-hospital stroke, myocardial infarction or death at 30 days after carotid revascularization, whether TCAR or carotid endarterectomy (CEA).

“Our results demonstrate that VQI [Vascular Quality Initiative] centers who offer TCAR achieve lower rates of adverse events after carotid surgery when compared to centres who do not offer the new procedure,” said lead author Jesse Columbo, MD, a vascular surgeon at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. “We believe this indicates that centers that offer TCAR are able to better align patients with the best procedure for their individual clinical and anatomic characteristics.”

The analysis studied 86,027 patients who underwent carotid procedures between 2015 and 2019 using retrospective data from the VQI registry, a consortium of more than 400 centers in North America. In total, 7,664 patients (8.9%) underwent TCAR and 78,363 patients (91.1%) underwent CEA. The analysis cited increased use of TCAR, with 15 centers performing both TCAR and CEA at the beginning of the analysis period (2015), increasing to 247 centers at the end of the analysis period (2019), which represents a more than 16-fold increase in centers performing TCAR. The use of TCAR as a percentage of total carotid revascularization procedures also increased, from 90 of 12,276 procedures (0.7%) in 2015 to 2,718 of 15,956 procedures (17.0%) in 2019, which represents a 24-fold increase over five years.

Importantly, the analysis also revealed centers that adopted TCAR had a 10% reduction in the likelihood of MACE at 12 months compared to those centers that continued to perform CEA alone (odds ratio, 0.90; 95% confidence interval [CI], 0.81–0.99; p=0.04).

SOURCE: doi:10.1001/jamanetworkopen.2020.37885

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