Safety Profile Similar in Carotid Revascularization Procedures in Men, Women

Internal Carotid artery puncture, interventional
A group of researchers examined the safety and benefits of TCAR, TFCAS, and CEA in men and women.

Transcarotid artery revascularization (TCAR) outcomes are comparable to carotid endarterectomy (CEA), according to study findings published in the Annals of Vascular Surgery.

For the retrospective analysis, researchers from the University of California San Diego sourced data from the Society for Vascular Surgery Vascular Quality Initiative CEA and coronary artery stenting (CAS) registries, collected between 2016 and 2019. Clinical outcomes after TCAR, transfemoral CAS (TFCAS), and CEA were assessed on the basis of sex.

Data were available from a total of 75,538 patients, of whom 38.3% were women. Among the women, 75.3% underwent CEA, 13.9% TFCAS, and 10.9% TCAR. Among men, 72.4% underwent CEA, 15.7% TFCAS, and 11.9% TCAR. Stratified by procedure and sex, almost all baseline characteristics differed significantly.

In the fully adjusted model, women who underwent TFCAS were associated with increased risk for in-hospital death (adjusted odds ratio [aOR], 4.95; P <.001); stroke or death (aOR, 2.85; P <.001); stroke, death, or myocardial infarction (aOR, 2.23; P <.001); transient ischemic attack (TIA; aOR, 2.01; P =.010); stroke or TIA (aOR, 1.96; P <.001); and stroke (aOR, 1.93; P =.001) compared with CEA. TCAR associated with increased risk for TIA compared with CEA (aOR, 1.30; P =.3).

At 1 year, rates of stroke or death among women were 9.5% for TFCAS, 4.6% for TCAR, and 7.1% for CEA (P <.001). Only TFCAS associated with increased risk of stroke or death at 1 year (adjusted hazard ratio [aHR], 1.48; P <.001).

For the men, in the adjusted analysis, TFCAS associated with increased risk for in-hospital death (aOR, 3.45; P <.001); stroke or death (aOR, 1.74; P <.001); and stroke, death, and myocardial infarction (aOR, 1.44; P <.001) compared with CEA. TCAR was associated with increased risk for stroke or TIA (aOR, 1.30; P =.047) and decreased risk for myocardial infarction (aOR, 0.52; P =.003) compared with CEA.

At 1 year, rates of recurrent ipsilateral stroke or death were 10.0% for TFCAS, 4.8% for TCAR, and 7.9% for CEA (P <.001). Similar to women, TFCAS increased risk for 1-year stroke or death (aHR, 1.36; P <.001).

This study may have been biased by the heterogenous patient population, so these findings may not be generalizable to more diverse populations.

These data indicated that TCAR had a similar safety profile to CEA among both men and women, although TFCAS was associated with poorer clinical outcomes in the short- and long-term.

“…TCAR is a safe alternative to CEA particularly in women when surgical risk prohibits CEA,” the study authors noted.


Cui CL, Zarrintan S, Marmor RA, Nichols J, Cajas-Monson L, Malas M. Performance of carotid revascularization procedures as modified by sex. Ann Vasc Surg. Published online November 6, 2021. doi:10.1016/j.avsg.2021.08.051