Scientific publications
An International, Expert-Based Delphi Consensus Document on Controversial Issues about TransCarotid Artery Revascularization (TCAR). Scientific Publication
Kosmas I Paraskevas 1 , Ali F AbuRahma 2 , Christopher J Abularrage 3 , Daniel G Clair 4 , Jens Eldrup-Jorgensen 5 , Vikram S Kashyap 6 , Alan Dardik 7 , Gert J de Borst 8 , Meghan Dermody 9 , Gianluca Faggioli 10 , Caitlin W Hicks 3 , Christopher J Kwolek 11 , Sean P Lyden 12 , Armando Mansilha 13 , Isabelle Van Herzeele 14 , Piotr Myrcha 15 , Jose Ignacio Leal Lorenzo 16 , Jeffrey Jim 17 , Rodolfo Pini 10 , Eric A Secemsky 18 , Francesco Spinelli 19 , Laura Capoccia 20 , David H Stone 21 , Michael C Stoner 22 , Clark J Zeebregts 23 , Brajesh K Lal 24 , Peter A Schneider 25 , Mahmoud B Malas 26 , Marc L Schermerhorn 27
Objective: TransCarotid Artery Revascularization (TCAR) has emerged as an alternative therapeutic modality to carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TFCAS) for the management of patients with carotid artery stenosis. However, certain issues regarding the indications and contraindications of TCAR remain unanswered or unresolved. The aim of this international, expert-based Delphi Consensus document was to attempt to provide some guidance on these topics.
Methods: A 3-Round Delphi Consensus process was performed including 29 experts. The aim of Round 1 was to investigate the differing views and opinions of the participants. Round 2 was carried out after the results from the literature on each topic were provided to the participants. During Round 3, the participants had the opportunity to finalize their vote.
Results: Most participants agreed that TCAR can/can probably/possibly be performed within 14 days of a cerebrovascular event, but it is best to avoid it in the first 48 hours. It was felt that TCAR cannot/should not replace TFCAS or CEA, as each procedure has specific indications and contraindications. Symptomatic patients >80 years should probably be treated with TCAR rather than with TFCAS. TCAR can/can probably be used for the treatment of restenosis following CEA/TFCAS. Finally, there is a need for a randomized controlled trial to provide better evidence for the unresolved issues.
Conclusions: This Delphi Consensus document attempted to assist the decision-making of physicians/interventionalists/vascular surgeons involved in the management of carotid stenosis patients. Furthermore, areas requiring additional research were identified. Future studies and randomized controlled trials should provide more evidence to address the unanswered questions regarding TCAR.
CITATION Ann Vasc Surg. 2024 Oct 14:S0890-5096(24)00624-1. doi: 10.1016/j.avsg.2024.09.048
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