1635_Bianchi.pdf

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1、Trans-Femoral vs.TCAR vs.CEA:How Do I Choose?Does It Matter?Christian Bianchi,MD DFSVS FACS Associate Professor Cardiovascular SurgeryLoma Linda University University of California RiversideFounder,Western Vascular AMCDisclosuresCBI(not AI)was used in the creation of this content Best Medical therap

2、y CEA TF-CAS TCAR Antiplatelet/LDL 70 /BP 50%remains unchallenged(In hospital 4%stroke rate)Periprocedural stroke risk is enhanced Risk increases:Ocular TIA+/Hemispheric TIA+/Stroke+/modified Rankin score)Asymptomatic 70%with life expectancy 3 years(In hospital 3%stroke rate)Is again under scientifi

3、c scrutiny due to advances in medical therapy and lifestyle changes(Awaiting CREST 2)Tools predicting future stroke are important for decision making Restenosis 2.Patient driven factorsCEA(cohort 31,939 patients)TCAR(cohort 15,851 patients)TFCAS(35,346 patients)Periprocedural stroke predictors:NO ag

4、e Age 80 Age 75Gender (female)NO gender Gender(female)BP130/80 mmhg.BP130/80 mmhg.BP130/80 mmhg.ASA 4-5 ASA 4-5 ASA 4-5 eGFR/CKD eGFR CKD e GFR CKD CAD Contralateral carotid disease Contralateral carotid disease AnemiaRemote Stroke(180 days)Remote Stroke(180 days)Remote Stroke(180 days)Periprocedura

5、l MAE predictors:CAD-CHF Severe COPD CAD-CHF Severe COPD CAD-CHF Severe COPD2.Patient driven factors3.Anatomic stratification:Access anatomyFemoral Occlusive/redo/groin hostile Radial3.Anatomic stratification:Access anatomyNeck anatomyNeck range of motionPrior surgeryPrior radiation Aortic arch type

6、 III Cohort (35,246 patients)3.Anatomic stratification:3.Anatomic stratification:ICA target CalcificationCohort (21,850 patients)tfCAS Circumferential Ca Increased stroke-deathTCAR 50-99%Ca Increased stroke-death-MIOverall incidence 50-99%calcification rate is 34%3.Anatomic strat