Outcomes of Carotid Stenting for Nonatherosclerotic Disease
Recommended Citation
Halabi M, Chamseddine H, Shepard A, Nypaver T, Weaver M, Boules T, Peshkepija A, Kavousi Y, Onofrey K, Rteil AH, Kabbani L. Outcomes of Carotid Stenting for Nonatherosclerotic Disease. J Vasc Surg 2025; 81(6):e285-e286.
Document Type
Conference Proceeding
Publication Date
6-1-2025
Publication Title
J Vasc Surg
Abstract
Objective: Carotid artery stenting (CAS) is a well-recognized treatment for atherosclerotic carotid artery disease; recent studies have demonstrated that transcarotid artery revascularization (TCAR) is associated with lower risks of stroke and death compared with transfemoral CAS (tfCAS) in patients with atherosclerotic carotid stenosis. The comparative outcomes of these techniques in nonatherosclerotic carotid diseases—dissection, trauma, and fibromuscular dysplasia (FMD)—however remain underexplored. This study aims to evaluate and compare the outcomes of tfCAS and TCAR in nonatherosclerotic carotid disease. Methods: Patients undergoing CAS for dissection, trauma, or FMD were identified in the Vascular Quality Initiative between 2016 and 2024. Demographics, procedural characteristics, and postoperative outcomes were compared between the two groups. Primary outcomes included stroke, death, and major adverse cardiovascular events (MACE) defined as a composite of stroke/myocardial infarction/death. Multivariate logistic regression was used to assess the differences in postoperative outcomes. Results: Among 818 patients (tfCAS: n = 590, TCAR: n = 228), TCAR patients were older (66.79 vs 58.35 years, P < .001), and had more hypertension (78.91% vs 64.2%, P < .001) and coronary artery disease (38.2% vs 25.8%, P < .001). Dissection was the most common etiology in both groups (TCAR: 78.5%, tfCAS: 79.5%), followed by trauma (TCAR: 8.8%, tfCAS: 8.8%) and FMD (TCAR: 12.7%, tfCAS: 9.7%). Intraoperatively, TCAR patients required slightly longer procedure times (75.5 minutes vs 69 minutes, P = .016). When comparing outcomes by etiology, there were no significant differences in stroke (P = .669) or MACE (P = .101) between the groups, while mortality was more common in trauma patients (trauma 7.1%, dissection 2.2%, FMD 1.2%, P = .017). When analyzing by procedure type, TCAR had significantly lower rates of MACE (2.2% vs 6.4%, P = .015) and death (0.4% vs 3.4%, P = .017), but a nonsignificant stroke advantage (1.3% vs 3.1%, P = .159). Multivariate analysis confirmed that TCAR was associated with a lower risk of MACE (odds ratio: 0.303, 95% confidence interval: 0.108-0.852, P = .024), but not stroke or death (Table). Conclusion: This study suggests that TCAR is associated with improved postoperative outcomes compared with tfCAS in patients with nonatherosclerotic carotid disease, notably in reducing MACE. These findings support the preferential use of TCAR in selected patients with nonatherosclerotic carotid artery disease. [Formula presented]
Volume
81
Issue
6
First Page
e285
Last Page
e286
