Transcervical carotid artery stenting compared to transfemoral carotid artery stenting and carotid endarterectomy: perioperative and short-term results from a single center

Background Carotid artery stenosis is a major cause of ischemic stroke. Various revascularization strategies exist, including Carotid Endarterectomy (CEA), Transfemoral Carotid Artery Stenting (TF-CAS), and Transcervical Carotid Artery Stenting (TC-CAS). This study aimed to compare the perioperative outcomes and six-month follow-up results among patients undergoing TC-CAS, TF-CAS, and CEA for carotid artery stenosis. Methods A retrospective analysis was performed on 220 patients undergoing carotid revascularization from 2020 to 2024. Patients were divided into three groups: TC-CAS (50), TF-CAS (81), and CEA (89). Primary endpoints included perioperative stroke and complications; secondary endpoints assessed six-month restenosis and stroke/TIA events. Results Perioperative stroke rates were low and comparable among all groups (TF-CAS 2.5%, TC-CAS 2.0%, CEA 1.1%; P = 0.802). Cranial nerve injury occurred exclusively in the CEA group. Six-month restenosis rates showed no significant difference (TF-CAS 3.7%, TC-CAS 2.0%, CEA 4.5%; P = 0.752), with no stroke or TIA events observed in the TC-CAS group. Hospital costs were significantly lower in the CEA group (25.0 ± 9.8 × 10 3 CNY) compared to TF-CAS (57.6 ± 22.8 × 10 3 CNY) and TC-CAS (56.4 ± 20.1 × 10 3 CNY) ( P < 0.001). Conclusion TC-CAS is a feasible and promising alternative to TF-CAS and CEA, offering favorable perioperative safety and short-term clinical outcomes. It is particularly suitable for patients with high-risk anatomy, but longer-term studies are required to confirm sustained efficacy.