Effectiveness of Transcarotid vs Transfemoral Carotid Stenting for Stroke Prevention

作者：Jesse A. Columbo, Pablo Martínez‐Camblor, David H. Stone, Philip P. Goodney, Mark A. Creager, Todd A. MacKenzie, Jialin Mao, Aruna D. Pradhan, Sanuja Bose, Haobin Chen, A. James O’Malley, Caitlin W. Hicks · 发表于：JAMA Network Open · 年份：2025 · DOI：10.1001/jamanetworkopen.2025.9143 · 被引用次数：15 · 研究领域：Cerebrovascular and Carotid Artery Diseases、Peripheral Artery Disease Management、Acute Ischemic Stroke Management

Importance: The effectiveness of surgical transcarotid artery revascularization (TCAR) compared with percutaneous transfemoral carotid artery stenting (TF-CAS) for stroke prevention beyond the periprocedural period is poorly quantified. Objective: To compare the risk of stroke after TCAR vs TF-CAS. Design, Setting, and Participants: This retrospective cohort study used data from the Vascular Implant Surveillance and Outcomes Network (VISION), a procedural registry linked to Medicare claims data that captures clinical, procedural, and outcome data on patients who underwent carotid stenting. Patients who underwent TCAR or TF-CAS between October 1, 2016, and December 31, 2019, and were captured in the VISION database were included. Data were analyzed between January and June 2024. Exposure: Type of carotid stenting (TCAR vs TF-CAS). Main Outcomes and Measures: The primary outcomes were any stroke, including both periprocedural and during follow-up, defined using a validated claims code list, and death. Asymptomatic and symptomatic patients were analyzed separately. Kaplan-Meier analysis was used to calculate the cumulative incidence of the outcomes, and a multivariable Cox proportional hazards model was used to determine hazard ratios (HRs). Results: There were 5798 asymptomatic patients (mean [SD] age, 74.6 [7.7] years; 3631 male [62.6%]; 3482 underwent TCAR; 2316 underwent TF-CAS) and 4721 symptomatic patients (mean [SD] age, 74.2 [8.3] years; 2969 male [62.9%]; 2377 underwent...