Scientific Sessions 2025
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Innovations in Stroke and Cerebrovascular Disease
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Transcarotid Artery Revascularisation (TCAR) versus Transfemoral Carotid Artery Stenting (TFCAS) versus Carotid Endarterectomy (CEA) for Treatment of Carotid Artery Stenosis: A Systematic Review and Network Meta-Analysis of Intra-Hospital Mortality and Stroke
American Heart Association
19
0
Final ID: MP2561
Transcarotid Artery Revascularisation (TCAR) versus Transfemoral Carotid Artery Stenting (TFCAS) versus Carotid Endarterectomy (CEA) for Treatment of Carotid Artery Stenosis: A Systematic Review and Network Meta-Analysis of Intra-Hospital Mortality and Stroke
Abstract Body (Do not enter title and authors here): Introduction Carotid artery stenosis (CAS) is a significant cause of stroke, and its optimal surgical management remains debated. While carotid endarterectomy (CEA) has been the gold standard, transcarotid artery revascularisation (TCAR) and transfemoral carotid artery stenting (TFCAS) have emerged as less invasive alternatives. However, comparative data on their perioperative and postoperative outcomes are limited. This network meta-analysis (NMA) evaluates the relative safety of TCAR, TFCAS, and CEA in terms of mortality and stroke in patients suffering from CAS. Research Question What are the comparative outcomes of TCAR, TFCAS, and CEA in terms of intra-hospital mortality, intra-hospital stroke, intra-hospital myocardial infarction (MI), and transient ischemic attack (TIA) in patients with CAS? Methodology We conducted a Bayesian NMA using a random-effects model, synthesising data from 11 studies (n=157,767 patients). The analysis included direct and indirect comparisons between TCAR, TFCAS, and CEA. Primary outcomes were intra-hospital mortality and stroke, with secondary outcomes of MI and TIA. We calculated odds ratios (OR) with 95% credible intervals (CrI) and ranked treatments using surface under the cumulative ranking curve (SUCRA) probabilities. Multi-criteria decision analysis (MCDA) was used to rank interventions on the basis of all outcomes. Results Our NMA included 11 studies involving 157,767 patients. For intra-hospital mortality, TCAR showed a trend toward lower mortality compared to TFCAS (OR 0.59, 95% CrI 0.33–1.05) and CEA (OR 0.87, 95% CrI 0.38–1.98), ranking highest (SUCRA 76.3%). For intra-hospital stroke, TCAR was superior to TFCAS (OR 0.50, 95% CrI 0.34–0.74) and comparable to CEA (OR 1.82, 95% CrI 0.96–3.45), again ranking highest (SUCRA 83.5%). TFCAS consistently performed worst for both mortality (SUCRA 15.6%) and stroke (SUCRA 20.3%). No significant differences were observed for MI (TCAR SUCRA 61.4%, CEA 52.8%, TFCAS 35.8%) or TIA (TCAR SUCRA 81.2%, CEA 48.6%, TFCAS 20.2%).
This NMA demonstrates that TCAR is associated with the most favourable outcomes for perioperative mortality and stroke prevention, outperforming TFCAS and showing comparable safety to CEA. TFCAS consistently ranked lowest for safety endpoints, suggesting it should be used selectively. Keywords:. Transcarotid artery revascularisation; Transfemoral carotid artery stenting; Carotid endarterectomy; Carotid Artery Stenosis
Bin Zahid, Muhammad Maaz
( Khyber Medical Collage, Peshawar
, Peshawar
, Pakistan
)
Khan, Muhammad Haris
( Khyber Medical Collage, Peshawar
, Peshawar
, Pakistan
)
Malik, Muhammad Hashim
( Khyber Medical Collage, Peshawar
, Peshawar
, Pakistan
)
Afridi, Abdullah
( Khyber Medical Collage, Peshawar
, Peshawar
, Pakistan
)
Author Disclosures:
Muhammad Maaz Bin Zahid:DO NOT have relevant financial relationships
| Touba Azeem:No Answer
| Afra Khan:DO NOT have relevant financial relationships
| Alishba Hameed:DO NOT have relevant financial relationships
| Iqra Khaksar:No Answer
| Muhammad Khan:DO NOT have relevant financial relationships
| Muhammad Hashim Malik:No Answer
| Abdullah Afridi:No Answer
