SAIMSARA Journal

Machine Generated Science • ISSN 3054-3991

Transcarotid Artery Revascularization vs Carotid Artery Stenting: Scoping Review with ☸️SAIMSARA.

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Vascular Health

Issue 1, Volume 1, 2026

Editorial note
• Last update: 2026-04-02 20:59:49
What is this paper about
This review shows that TCAR is not just another carotid stenting technique, but a potentially safer endovascular strategy with a recurrent signal for lower stroke and death risk than transfemoral CAS, especially when neuroprotection matters most. The full read is worth it because it clarifies where that advantage looks strongest, where the evidence is still mixed, and which anatomical, symptomatic, and restenotic subgroups may truly benefit from TCAR.

DOI: 10.62487/saimsara1247267

Abstract: To synthesize contemporary evidence comparing the perioperative and long-term outcomes of TCAR versus CAS in patients with carotid artery disease. The review utilises 37 original studies with 1685306 total participants (topic deduplicated ΣN). The evidence map consistently indicates that TCAR is associated with safer neurologic outcomes than transfemoral CAS, with perioperative stroke/death reported as 1.6% versus 2.9% in one large registry comparison and 1.6% versus 5.2% when compared with transfemoral stenting using distal embolic protection. Longer-term signals also favored TCAR, including lower 3-year stroke risk in asymptomatic patients (5.1% vs 9.2%) and symptomatic patients (16.6% vs 20.9%). Across the mapped literature, this advantage appears biologically plausible because studies comparing protection strategies suggest that direct carotid access with dynamic flow reversal may provide better neuroprotection than conventional transfemoral approaches and distal filters. Clinically, these findings support TCAR as the preferred endovascular option when carotid revascularization is needed but CEA is less suitable, while also underscoring the importance of anatomy, lesion calcification, and postoperative hemodynamic management in patient selection. Because the current evidence base is largely retrospective and heterogeneous across CAS techniques, the next priority is prospective head-to-head evaluation that standardizes comparator strategy and clarifies which symptomatic, restenotic, and anatomically complex subgroups derive the greatest benefit from TCAR.
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Keywords: Transcarotid artery revascularization; Carotid artery stenting; Carotid endarterectomy; Carotid artery stenosis; Stroke risk; Vascular Quality Initiative; Transfemoral carotid stenting; Cerebral hyperperfusion syndrome; Perioperative outcomes; Flow reversal

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