LAUSR

BACKGROUND Transcarotid artery revascularization (TCAR) is a hybrid approach to carotid revascularization. There is limited information on differences in periprocedural complications and performance measures of TCAR in men compared to women, and in older compared to younger adults. METHODS Patient, lesion, and physician characteristics were collected on all TCAR procedures performed by each physician worldwide in an international Quality Assurance database between March 3, 2009 and May 7, 2020. Clinical composite (death, stroke, transient ischemic attack, myocardial infarction) and technical composite adverse events (aborted procedure, conversion to surgery, bleeding, dissection, cranial-nerve injury, device failure) within 24 hours of the procedure were recorded. Four performance measures were recorded: flow-reversal time, fluoroscopy time, contrast volume, and skin-to-skin time. Poisson regressions were used to assess the impact of age and sex on clinical and technical composite adverse events. Linear regressions were used to compare the four performance measures. RESULTS 18,240 TCARs were performed by 1,273 physicians; 34.9% of patients were women and 37.5% were symptomatic. Overall clinical and technical composite adverse events were low. Adjusted rates of clinical (1.62% [95% confidence intervals 1.17, 2.23] vs 1.35% [1.01,1.79], p=0.22) and technical (7.84% [6.85, 8.97] vs 7.80% [6.94, 8.77], p=0.93) composite adverse event rates did not vary for women vs men. Adjusted clinical (p=0.65) and technical (p=0.55) composite adverse event rates also did not vary by age. Adjusted skin-to-skin time was shorter in females (76.6 minutes [74.6, 78.6]) vs males (77.7 minutes [75.7,79.6], p=0.002). There were significant differences by age-group for fluoroscopy time, flow-reversal time, and skin-to-skin time, though the magnitude of these differences were small (<1 minute for each). CONCLUSIONS Clinical and technical outcomes of TCAR are not impacted by age or sex. There are clinically minor differences in procedural performance measures by age and sex. In addition to being safe in younger individuals, it may also be a preferred method of performing carotid stenting in women and in older patients, and particularly in older women.