National Trends of Operative Experience for Carotid Endarterectomy and Carotid Stenting for Vascular Surgery Trainees

The United States Food and Drug Administration granted approval for transcarotid artery revascularization (TCAR) in 2015 as an alternative option for carotid stenosis in high-risk patients. Initial data has shown TCAR has comparable stroke rates to carotid endarterectomy (CEA). With increasing utilization of TCAR by vascular surgeons, we aimed to analyze the trends of operative volume for carotid artery stenosis among both graduating integrated vascular surgery residents (IVRs) and vascular surgery fellows (VFs) and its impact on the standard open CEA. National case log data from the Accreditation Council for Graduate Medical Education (ACGME) were reviewed from years 2014 to 2023 for both IVRs and VFs. Trends in the operative volume of carotid stenting and CEAs were evaluated via linear regression analysis. A t-test was used to compare the total number of procedures between the two groups. Over the 9-year period of study, IVRs performed an average of 19% more CEA procedures (P < .01) and 1.3% more carotid stent procedures (P = .92) compared to VF trainees. The number of carotid stent procedures per trainee in both IVR and VF graduates increased during this period, whereas the number of CEAs have decreased. Total carotid stent cases per trainee increased from 7.7 to 16.1 for IVR (+1.05 case/year; R2 = .94; P < .01) and 8 to 14.3 for VF (+.78 case/year; R2 = .92; P < .01) (Fig 1). Total CEA cases per trainee decreased from 52 to 41.9 for IVR (−1.27 case/year; R2 = .62; P = .012) and 48.5 to 39.9 for VF (−1.08 case/year; R2 = .87; P < .01) (Fig 1). After the approval of TCAR, there was a significant increase in carotid stent procedures and decrease in CEAs among trainees in both IVR and VF programs. Further trends should continue to be observed in the future to ensure trainees have adequate skills for carotid stenting but not at the expense of CEA.