Home›Neurology› Transcarotid Artery Revascularization shows lower 30-day stroke and death risk compared to TF-CAS
Transcarotid Artery Revascularization shows lower 30-day stroke and death risk compared to TF-CASNew data shows TCAR may lower risks for carotid artery disease
Translational stroke researchPublished June 10, 2026Study authors: Jiang Zhi-Cheng, Hu Qi-Fei, Huang Jia-Ming, Wang Xian-Wei, Lin Tong, Gao Xi-Lin, Cui Jia-Wen, Zhao J…PubMed ↗DOI ↗Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain
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Key Takeaway
Note TCAR shows significantly lower 30-day stroke and death risk compared to TF-CAS in carotid stenosis patients.
This meta-analysis evaluates the comparative outcomes of Transcarotid Artery Revascularization (TCAR) against Carotid Endarterectomy (CEA) and Transfemoral Carotid Artery Stenting (TF-CAS) in patients with carotid stenosis. The analysis includes both mixed populations and specific data from asymptomatic subgroups.
At 30 days, TCAR showed no significant difference compared to CEA for stroke (RR, 1.25), death (RR, 0.94), or combined stroke or death (RR, 1.10). However, TCAR was associated with less frequent myocardial infarction at 30 days compared to CEA (RR, 0.68). When compared to TF-CAS at 30 days, TCAR showed significantly lower risk for stroke (RR, 0.60), death (RR, 0.55), and combined stroke or death (RR, 0.60).
At the 1-year mark, TCAR results versus CEA showed no significant difference in stroke (RR, 1.27) or death (RR, 1.14), while the combination of stroke or death favored CEA (RR, 1.25). Compared to TF-CAS at 1 year, TCAR showed comparable results for stroke (RR, 0.75) and a significant difference in death (RR, 1.09), with combined outcomes favoring TCAR (RR, 0.79).
The authors note that evidence specifically for asymptomatic carotid disease is limited and derived primarily from observational analyses of clinical databases and small amounts of single-center retrospective data. Clinical application should consider these limitations when comparing revascularization techniques.
When a person has a narrowed artery in the neck, known as carotid stenosis, doctors must choose the best way to clear the blockage and prevent a stroke. This is a high-stakes decision for anyone who hasn't shown symptoms yet but knows their arteries are at risk.
A large review of data compared two main methods: TCAR (a specialized revascularization) and traditional options like surgery or stenting. The findings show that TCAR performed similarly to standard surgery in terms of stroke and death rates over the first year. However, when compared specifically against stenting (TF-CAS), TCAR showed a significantly lower risk of stroke and death within the first 30 days.
While the results are promising for TCAR, it is important to note that much of this evidence comes from observational data rather than large controlled trials. Because the available data for people without symptoms is still limited, patients should talk to their doctors to decide which procedure fits their specific health profile.
What this means for you:
TCAR shows a lower risk of stroke and death in the first 30 days compared to stenting for carotid artery issues.
Common questions
How does TCAR compare to standard surgery?
When comparing TCAR to traditional surgery (CEA), there was no significant difference in stroke or death rates at 30 days or after one year. However, TCAR did show a lower risk of heart attacks within the first 30 days compared to the surgical option.
Is TCAR safer than stenting for carotid artery issues?
Yes, when comparing TCAR to stenting (TF-CAS), TCAR showed a significantly lower risk of stroke and death within 30 days. At the one-year mark, TCAR also favored better outcomes regarding combined stroke or death rates compared to stenting.
Is this finding certain for everyone with carotid stenosis?
The evidence is still limited because much of it comes from observational data and clinical databases rather than large trials. Because the data for people without symptoms is not yet complete, you should discuss these specific results with your doctor.
Management of asymptomatic carotid stenosis remains controversial despite advances in contemporary best medical therapy. Transcarotid artery revascularization (TCAR) has been introduced as an alternative revascularization option alongside carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS). Evidence focused specifically on asymptomatic carotid disease, however, remains limited and is derived mainly from observational analyses of clinical databases, with only a small amount of single-center retrospective evidence. The present study therefore examined the available comparative evidence on TCAR for asymptomatic carotid stenosis. A systematic review and meta-analysis was performed of studies reporting outcomes of TCAR in asymptomatic carotid stenosis. Eligible studies included asymptomatic cohorts or mixed populations with extractable asymptomatic subgroup data and reported outcomes after TCAR with comparison against CEA and/or TF-CAS. The primary pooled outcomes were stroke, death, stroke or death, and myocardial infarction at 30 days, together with the corresponding stroke, death, and stroke or death outcomes at approximately 1 year. For TCAR versus CEA, no significant between-group differences were identified in the pooled 30-day risks of stroke (risk ratio (RR), 1.25; 95% CI, 0.98-1.59; I²=82%), death (RR, 0.94; 95% CI, 0.64-1.38; I²=57%), or stroke or death (RR, 1.10; 95% CI, 0.95-1.26; I²=75%). In contrast, myocardial infarction within 30 days occurred less frequently after TCAR (RR, 0.68; 95% CI, 0.48-0.96; I²=71%). At approximately 1 year, pooled estimates likewise showed no significant difference in stroke (RR, 1.27; 95% CI, 0.70-2.29; I²=0%) or death (RR, 1.14; 95% CI, 0.97-1.35; I²=0%), whereas the pooled estimate for stroke or death favored CEA (RR, 1.25; 95% CI, 1.15-1.36; I²=31%). A different pattern emerged in the TCAR versus TF-CAS comparison. TCAR was associated with significantly lower pooled 30-day risks of stroke (RR, 0.60; 95% CI, 0.48-0.73; I²=0%), death (RR, 0.55; 95% CI, 0.38-0.81; I²=20%), and stroke or death (RR, 0.60; 95% CI, 0.52-0.70; I²=6%), while no significant difference was observed for 30-day myocardial infarction (RR, 0.91; 95% CI, 0.65-1.29; I²=44%). At approximately 1 year, stroke remained comparable between the 2 groups (RR, 0.75; 95% CI, 0.46-1.23; I²=26%), whereas death (RR, 1.09; 95% CI, 1.00-1.20; I²=66%) and stroke or death (RR, 0.79; 95% CI, 0.71-0.87; I²=45%) differed, with the pooled stroke-or-death estimate favoring TCAR. Current observational evidence suggests that TCAR compares favorably with TF-CAS in asymptomatic carotid stenosis. When compared with CEA, TCAR does not appear to provide a clear benefit in pooled perioperative neurologic outcomes, although myocardial infarction may occur less frequently after TCAR.
