Perioperative predictors of hemodynamic instability after carotid revascularization

Authors

• Lutfi Barghuthi, University of Chicago Medical Center
• Rebekah Bjorklund, University of Texas at Tyler
• Mya Phelps, University of Texas at Tyler
• Shrina Patel, University of Texas at Tyler
• LaKecia Beasley, University of Texas at Tyler
• Bayli Zink, University of Texas at Tyler
• Alyssa Bedell, University of Texas at Tyler
• Gaurav Singh, University of Texas at Tyler
• Sarah Stokke, University of Texas at Tyler
• Jacob Dunn, UT Health East Texas
• Lily Sadri, University of Texas at Austin
• Carly Wadle, University of Texas at Tyler
• Alisha Thedford, University of Texas at Tyler
• Rebecca Swindall, University of Texas at Tyler
• Alan Cook, University of Texas at Tyler
• Hishaam Ismael, University of Texas at Tyler
• Mark Robbins, University of Texas at Tyler

Document Type

Article

Publication Date

2026

Abstract

Objective

Postoperative hemodynamic instability after carotid revascularization can lead to adverse outcomes such as intensive care unit admission and prolonged hospitalization, leading to an increase in resource utilization. This study aimed to compare hemodynamic instability between transcarotid artery revascularization (TCAR) and carotid endarterectomy (CEA).

Methods

A retrospective cohort study was conducted at a single institution on treatment for carotid artery stenosis between 2021 and 2024. Clinical outcomes after TCAR and CEA were compared. The primary outcome was hemodynamic instability; secondary outcomes of interest included any >30-day complication or death.

Results

In total, 566 patients were included, 71.2% undergoing TCAR (n = 403) and 28.8% undergoing CEA (n = 163). Compared with CEA, TCAR patients were more likely to be symptomatic (48.4% vs 35.6%) and receive preoperative beta-blockers (28.3% vs 9.2%). Postoperatively, hemodynamic instability occurred more frequently after TCAR (29.8% vs 20.3%) with higher rates of intensive care unit admission (34% vs 16.6%). In multivariable analysis adjusting for baseline physiological status, TCAR was independently associated with higher odds (adjusted odd ratio, 1.67; 95% confidence interval, 1.07-2.63) of postoperative hemodynamic instability, whereas prior stroke or transient ischemic attack was associated with a lower odds (adjusted odd ratio, 0.64; 95% confidence interval, 0.43-0.94). American Society of Anesthesiologists class and beta-blocker use were not independently associated.

Conclusions

Postoperative instability appeared to be influenced more by perioperative physiology and patient presentation than by adverse procedural outcomes. TCAR demonstrated lower complication and mortality rates despite higher postoperative instability, supporting its safe use in hospitals when paired with optimized perioperative management and vigilant monitoring.

Description

Copyright 2026 THE AUTHOR(S). Published by ELSEVIER INC. on behalf of the Society for Vascular Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Persistant Identifier

http://hdl.handle.net/10950/5166

Publisher

Elsevier

Permanent Email Address

[email protected]

Recommended Citation

Barghuthi, Lutfi; Bjorklund, Rebekah; Phelps, Mya; Patel, Shrina; Beasley, LaKecia; Zink, Bayli; Bedell, Alyssa; Singh, Gaurav; Stokke, Sarah; Dunn, Jacob; Sadri, Lily; Wadle, Carly; Thedford, Alisha; Swindall, Rebecca; Cook, Alan; Ismael, Hishaam; and Robbins, Mark, "Perioperative predictors of hemodynamic instability after carotid revascularization" (2026). School of Medicine Faculty Publications and Presentations. Paper 25.