SS06 - Reintervention Following Transcarotid Artery Revascularization

Objectives: Transcarotid artery revascularization (TCAR) has been increasingly utilized for the management of patients with carotid artery stenosis after its US Food and Drug Administration (FDA) approval in 2015. While outcomes following TCAR are well reported, data regarding reinterventions after TCAR remain limited. The aim of our current study was to report the reintervention rate following TCAR and the management strategies.

Methods: We performed retrospective analysis of our prospectively maintained database of all consecutive TCAR procedures performed between September 2017 to November 2025. Demographics, procedural details, perioperative outcomes and long-term outcomes ipsilateral cerebrovascular accident (CVA), overall survival, and reintervention rates were analysed. Kaplan-Meier analysis was used to report time to event data.

Results: A total of 1086 patients underwent TCAR during the study period. 56.3% (n=611) were males and median age was 74.8 years. Comorbidities included coronary artery disease (44%), chronic obstructive pulmonary disease (15.1%), diabetes mellitus (45.1%), dialysis-dependence (3.9%), and 18.4% were active smokers. Median Charlson Comorbidity Index score was 5. Preoperatively, 30.7% patients were symptomatic, with a median time to revascularization of 5 days (Table I). Technical success of TCAR in our cohort was 98.3% with a need to open conversion in 1.2%. Thirty-day rates of ipsilateral CVA, myocardial infarction and mortality were 1.7%, 0.3% and 0.8%, respectively. Median duration of clinical follow-up was 9.1 months (range, 0 to 89.8 months). On Kaplan-Meier analysis, freedom for ipsilateral CVA at one, three and five years was 97.6%, 96.4%, and 95.9%, respectively. Similarly, overall survival at one, three and five years was 96.1%, 92.6%, and 90.3%, respectively. During follow-up, 12(1.1%) patients required reintervention. Median time to reintervention was 24 months (range 0 to 56 months). The most common indication was instent restenosis >70% (n=8, 66.7%), followed by common carotid artery stenosis proximal to patent stent (n=2), crushed TCAR stent (n=1) and dissection causing stent stenosis (n=1). Reintervention was managed by endovascular techniques in 67% (Table II). Technical success of reintervention was 100%.

Conclusions: In our cohort of patients, TCAR demonstrated a low and acceptable reintervention rate of 1.1% during the follow-up. Reinterventions were infrequent and could be managed successfully using both endovascular and open revascularization techniques. Treatment strategy should be individualized based on restenosis anatomy and patient-specific risk factors to achieve excellent technical success.