From the Research
The anatomic criteria for transcarotid artery revascularization (TCAR) include a common carotid artery diameter of at least 6mm, a distance of at least 5cm between the clavicle and carotid bifurcation, and an internal carotid artery diameter of 4-9mm, as well as the absence of significant common carotid artery disease at the access site and excessive tortuosity of the carotid vessels. These criteria are based on the instructions for use of the ENROUTE Transcarotid Neuroprotection System, as reported in a study published in the Journal of Vascular Surgery in 2019 1. The study found that 72% of carotid arteries were eligible for TCAR based on these anatomic criteria, with 100% having a common carotid artery diameter of at least 6mm, 100% having an internal carotid artery diameter of 4-9mm, 75% having a distance of at least 5cm between the clavicle and carotid bifurcation, and 96% lacking significant common carotid artery disease at the access site.
Some key points to consider when evaluating a patient for TCAR include:
- The presence of a bovine arch, which may require special consideration during planning, but is not a contraindication for TCAR
- The absence of significant common carotid artery disease at the access site, which could complicate sheath placement
- The absence of excessive tortuosity of the carotid vessels, which could prevent proper device navigation
- The target lesion should be accessible from the common carotid artery approach, typically located in the internal carotid artery or at the carotid bifurcation
It's worth noting that while other studies have reported on the safety and efficacy of TCAR, such as the ROADSTER trial published in the Journal of Vascular Surgery in 2019 2, and technical tips for success in TCAR published in Seminars in Vascular Surgery in 2020 3, the anatomic criteria for TCAR remain the same. Additionally, the use of covered stents in TCAR has been reported to be safe and effective in select patients, as published in the Annals of Vascular Surgery in 2020 4. However, the most recent study published in Advances in Surgery in 2023 5 highlights the need for additional level-one studies to evaluate the long-term outcomes of TCAR in high- and standard-risk patients.
Overall, the anatomic criteria for TCAR are well-established and should be carefully evaluated when considering a patient for this procedure.