Post-Operative Hemodynamic Instability after TCAR (Transcarotid Artery Revascularization): A Retrospective Study

Authors

• Lutfi Barghuthi, University of Texas at Tyler
• 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
• Rebecca Swindall, University of Texas at Tyler
• Allen Cook, University of Texas at Tyler
• Mark Robbins, University of Texas at Tyler

Document Type

Article

Publication Date

5-2025

Abstract

Introduction: Postoperative hemodynamic instability following carotid revascularization can lead to adverse outcomes such as Intensive Care Unit (ICU) admission and prolonged hospitalization, leading to an increase in total hospital charges. This study aimed to compare hemodynamic instability between Transcarotid Artery Revascularization (TCAR) and Carotid Endarterectomy (CEA) in a rural setting. Methods: A retrospective cohort study was conducted at a single institution on treatment for carotid artery stenosis between 2021 and 2024. Clinical outcomes following TCAR and CEA were compared. The primary outcome was hemodynamic instability; secondary outcome was ICU admission. Results: In total, 546 patients were included, 72.5% undergoing TCAR (n-396) and 27.5% undergoing CEA (n-150). Compared with CEA, TCAR patients were more likely to be symptomatic (48.0% vs. 36.7%), receive preoperative beta blockers (28.5% vs. 8.0%), and require intraoperative pressors (91.9% vs. 85.3%). TCAR also had shorter operative times (49 vs. 76 minutes). In multivariable analysis, preoperative beta blocker use (OR: 2.3, 95% CI: 1.5 to 3.6) and intraoperative pressor administration (OR: 1.9, 95% CI: 1.1 to 3.3) were independent predictors of postoperative instability. Symptomatic presentation was associated with reduced risk (OR: 0.48, 95% CI: 0.30–0.76). TCAR itself was not an independent predictor after adjustment. ICU admission remained strongly associated with instability (OR: 11.3, 95% CI: 6.7 to 19.1). Conclusions: Postoperative instability was strongly influenced by preoperative beta blocker use and
intraoperative pressor requirements than by surgical approach. TCAR demonstrated shorter operative times and comparable outcomes to CEA, supporting its safe use in rural hospitals when paired with optimized perioperative management and vigilant monitoring.

Journal/Conference Details

Article post-print in JVS-Vascular Insights.

Persistent Identifier

http://hdl.handle.net/10950/5172

Copyright information

© 2026 The Author(s). Published by Elsevier Inc. on behalf of the Society for Vascular Surgery.

Recommended Citation

Barghuthi, L., Bjorklund, R., Phelps, M., Patel, S., Beasley, L., Zink, B., Bedell, A., Singh, G., Stokke, S., Dunn, J., Sadri, L., Wadle, C., Thedford, A., Swindall, R., Cook, A., Ismael, H., & Robbins, M. (2026). Perioperative predictors of hemodynamic instability after carotid revascularization. JVS-Vascular Insights, 4. https://doi.org/10.1016/j.jvsvi.2026.100394