The rising utilization and associated outcomes of transcarotid arterial revascularization

The purpose of this review is to provide a summary of indications, techniques and tips, outcomes and utilization of transcarotid artery revascularization (TCAR) stenting with flow reversal system. Subsections of procedural description; technical tips, technical complications and morbidities, outcomes and future applications are included. Following the PROOF feasibility trial in 2009, the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER) trial in 2012 was the initial prospective, multicenter clinical trial conducted to evaluate the safety and efficacy of TCAR (ENROUTE transcarotid neuroprotection system along with a variety of carotid artery stents). The ROADSTER trial involved 141 patients enrolled between November 2012 and July 2014, including symptomatic patients with ≥50% stenosis and asymptomatic patients with ≥70% stenosis. The results showed that within 30 days, the all-stroke rate was 1.4%, the combined rate of stroke and death was 2.8%, and the composite rate of stroke, death, and MI was 3.5%. At that time, the all-stroke rate of 1.4% was the lowest reported stroke rate for any prospective, multicenter clinical trial CAS. TCAR represents a significant advancement in the management of carotid artery disease, providing a unique combination of procedural safety, versatility, and innovation. Its flow reversal technology, which minimizes embolic risks in high-risk anatomical scenarios, sets it apart from other revascularization techniques. As ongoing studies and clinical trials clarify its long-term durability and outcomes, TCAR is positioned to play an increasingly crucial role in carotid revascularization. By delivering better outcomes and expanding access to minimally invasive care, TCAR is paving the way for a new standard in treating carotid artery disease across diverse patient populations.