TCAR a “phenomenal alternative” to carotid endarterectomy for high-risk patients


Keith Calligaro (Philadelphia, USA) interviews Vikram Kashyap (Cleveland, USA) for VEITHtv at VEITHsymposium 2019 (19–23 November, New York, USA) about whether transcarotid artery revascularisation (TCAR) might replace carotid endarterectomy (CEA) in the future. Kashyap says that although he has become an “enthusiast” of the TCAR procedure, the answer is “a bit more complicated”.

TCAR has become a “phenomenal alternative” to CEA for high-risk patients, says Kashyap, noting however that physicians still do not understand the morphology of the plaque and in cases where there are emoblisation concerns, “it may still be that CEA is the best option”.

Kashyap goes on to highlight data from the VQI database and the ROADSTER-2 study which have both indicated that TCAR is “almost analogous” to the results seen with CEA.

Calligaro, for his part, outlines his belief that TCAR could well outpace CEA in five years, so long as people are willing to adopt the technique and Kashyap concludes that the learning curve for TCAR is “very short” and that within a few cases a surgeon “becomes an expert at the procedure”.

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