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P1: Plenary Session 1: William J. von Liebig Forum

SS02 - Higher Stroke Risk after Carotid Endarterectomy Associated with Surgeons that Perform Transcarotid Revascularization for the Majority of Interventions

Wednesday, June 19, 2024
8:22 AM – 8:33 AM CT
Location: West Building, Level 3, Skyline Ballroom W375ab
Objectives: Adoption of transcarotid artery revascularization (TCAR) by surgeons has been variable, with many still performing traditional carotid endarterectomy (CEA), while others have shifted to mostly TCAR. Our goal was to evaluate the association of relative surgeon volume of CEA to TCAR with perioperative outcomes.

Methods: The Vascular Quality Initiative (VQI) CEA and carotid artery stent (CAS) registries were analyzed from 2021-2023. Surgeons participating in both registries were categorized in the following CEA to TCAR volume percentage ratios: 0-25/76-100 (majority TCAR), 26-50/51-75 (more TCAR), 51-75/26-50 (more CEA), 76-100/1-25 (majority CEA). Primary outcomes were rates of perioperative ipsilateral stroke, death, cranial nerve injury (CNI), and return to the operating room for bleeding (RTOR).

Results: There were 50,189 patients who underwent primary carotid revascularizations (64.3% CEA and 35.7% TCAR). CEA patients were younger (71.1 vs 73.5 years, P<.001), with less coronary artery disease and diabetes, fewer symptomatic cases, and lower antiplatelet and statin use (all P<.001). TCAR patients had lower rates of end stage renal disease, smoking, and obesity (all P<.001).

Post-operative stroke after CEA was significantly impacted by relative surgeon volume ratio (P=.04), with majority TCAR surgeons having higher post-operative ipsilateral stroke (OR 2.12, 95% CI 1.15 - 3.9, P=.02) (Table). There was a trend for higher stroke rate after TCAR in majority CEA surgeons, however, this did not reach significance. There was no association with relative volumes for perioperative death, cranial nerve injury, or return to the OR for bleeding for either procedure.

Conclusions: Relative surgeon CEA to TCAR ratio influenced CEA perioperative stroke rates, with higher TCAR volumes having a higher stroke risk. Surgeons should be comfortable and maintain experience with both operations and collaborate as needed.