Introduction: Transcarotid arterial revascularization (TCAR) is a relatively new technique used for revascularization of extracranial carotid disease. The aim of this technique is to reduce the risk of perioperative stroke that was observed in patients who underwent transfemoral stenting of the carotid artery (1). Since its introduction, multiple techniques have been introduced, including use of endovascular robots to decrease the amount of radiation exposure to the surgical team (2, 3). The aim of this study is to compare the outcomes between robot assisted and conventional TCAR, focusing on key procedural metrics.
Methods: We conducted a retrospective analysis of 24 patients who underwent TCAR between October 2020 and November 2023 at a single institution. Patient characteristics, including age, preoperative National Institutes of Health Stroke Scale (NIHSS) scores, and degree of carotid artery stenosis were assessed and compared between both groups. Procedural metrics analyzed included operative time, flow reversal time, contrast volume, and fluoroscopy time.
Results: Eighteen patients (75%) underwent traditional TCAR and six (25%) underwent robot assisted TCAR. Median follow up was 6 months (IQR 4 -8 months). The groups had comparable patient populations, with no significant differences in age (p=0.073), preoperative NIHSS scores (p=0.42), and preoperative carotid artery stenosis (p=0.12). Operative times were similar between the groups (p=0.8), as were flow reversal times (p=0.4), contrast volumes (p=0.55), and fluoroscopy times (p=0.66).
Conclusion : Robot assisted TCAR demonstrates procedural outcomes comparable to conventional TCAR, including operative time, flow reversal time, contrast volume, and fluoroscopy time but lower rates of radiation exposure for the surgical team.
Note: Figure 1 available on request.
References: 1. Schermerhorn et al. 2019, doi:10.1001/jama.2019.18441 2. Mohd et al. 2023, doi:10.7759/cureus.43263 3. Kurian, Lucke-Wold. 2023, Update on Management of Symptomatic Carotid Stenosis. J Neurosci Neurol Surg. 2023;13(1):255.
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