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Taste of Boston
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P7: Plenary 7/Late Breaking Abstracts

RS29 - Long-Term Outcomes of Carotid Revascularization for Asymptomatic Carotid Stenosis among Veterans Nationwide

Saturday, June 13, 2026
9:12 AM - 9:19 AM ET
Location: Hynes CC, Third Level, Ballroom A

    Presenting Author only(s)

  • ML

    Mary S. Lin

    PGY-3 General Surgery Resident
    University of Maryland School of Medicine, Baltimore, MD, USA

    • Co-Author(s)

  • MM

    Minerva Mayorga-Carlin

    Research Analyst
    University of Maryland School of Medicine, Baltimore, MD, USA
    Baltimore, Maryland

  • JS

    John D. Sorkin

    Professor of Medicine
    University of Maryland School of Medicine, Baltimore, MD, USA
    Pikesville, Maryland

    • Senior Author Discussant(s)

  • Brajesh K. Lal, MD

    Professor of Vascular Surgery
    University of Maryland School of Medicine, Baltimore, MD, USA
    Baltimore, Maryland

Objectives: CREST-2 demonstrated excellent results with TFCAS and low event-rates with CEA over 4 years of follow-up. TCAR was not included in the trial. Long-term outcomes after TCAR are not forthcoming, with most studies focused on periprocedural outcomes from registry data that is potentially subject to selection and/or reporting bias. We compared long-term stroke, death and myocardial infarction (MI) in all consecutive patients undergoing CEA, TCAR, or TFCAS for asymptomatic carotid stenosis in a nationwide cohort, using data extracted directly from electronic medical records (EMR).

Methods: The VA Informatics and Computing Infrastructure collates data from all EMRs from all 144 VA acute-care facilities nationwide. We extracted data for each consecutive patient undergoing carotid revascularization from 2015 through 2024. The primary predictor was revascularization-type (CEA, TCAR, TFCAS), defined by CPT-codes and by a review of operative-reports using a deep-learning natural-language-processing (NLP) algorithm developed by our group. The primary outcome was time to a composite of any stroke, death or MI following revascularization. Stroke and MI were defined using ICD-10 codes, and death using death-registry data. Demographic and clinical variables were also extracted. Due to a time-variant distribution of procedures (majority of TCARs were performed after 2017) we conducted a time-to-event analysis with a Cox proportional-hazards regression predicting time to the composite outcome by procedure, after adjusting for age, sex, race, and comorbidities.

Results: Of 69,303 procedures performed since 1990, 11,922 patients underwent revascularization for asymptomatic disease between 2015 and 2024; 9,546 underwent CEA, 1,057 TCAR, and 1,319 TFCAS. Average age of the cohort was 70.8 years, and the distribution of demographic and clinical features are shown in Table I. Our NLP algorithm for identification of TCAR and TFCAS in operative notes performed well (accuracy 97%). Hazard ratios for the composite outcome by procedure-type were generated from a Cox proportional-hazards regression model (Table 2). TFCAS had an increased risk for composite stroke-death-MI versus CEA (HR 1.58) and versus TCAR (HR 1.65), while there was no difference the outcome for TCAR versus CEA (HR 0.96).

Conclusions: For consecutive patients with asymptomatic high-grade carotid stenosis, the risk of a composite of any stroke, death, or MI after TFCAS was higher compared to CEA and to TCAR after an average follow-up of 4 years. The outcome for CEA and TCAR was not different. This is the most robust and unbiased comparison of long-term real-world outcomes for carotid revascularization procedures from data extracted directly from EMRs.