ObjectiveTo evaluate the safety, efficacy, and advantages of transcarotid artery revascularization (TCAR) in patients with high-risk carotid artery stenosis. MethodsThe patient was a 76-year-old male with severe symptomatic stenosis of the right internal carotid artery, complicated by multiple high-risk factors (such as cardiac insufficiency, history of coronary stent implantation, aortic calcification). Given his unsuitability for carotid endarterectomy and the high perioperative risk associated with transfemoral carotid artery stenting, TCAR was performed. The procedure involved puncturing the common carotid artery via a small cervical incision to establish a temporary carotid-to-femoral venous reversed-flow pathway. Following balloon predilation, a stent was deployed, and the reversed-flow system was used to divert potential plaque debris outward, thereby reducing the risk of intraoperative cerebral embolism. ResultsThe procedure was completed successfully. The operation time was approximately 70 min, the estimated blood loss was 20 mL. Postoperatively, the patient did not experience complications such as stroke, neurological deficit, or hyperperfusion syndrome. Although carotid sinus reflex-induced hypotension occurred, which stabilized after pharmacological management. The results of following-up at 3 months showed the stent was patent with no evidence of in-stent restenosis. ConclusionsThe findings of this case indicate that TCAR combines the cerebral protection advantages of carotid endarterectomy with the minimally invasive features of transfemoral carotid artery stenting. Its reversed-flow mechanism helps effectively prevent intraoperative embolism, offering a safe and viable revascularization option for patients with high-risk carotid artery stenosis.
ObjectiveSummarize advances in risk assessment and treatment of asymptomatic carotid artery stenosis and provide a reference for risk-stratified management and therapeutic decision-making. MethodsA systematic literature review was conducted based on studies of asymptomatic carotid artery stenosis both at home and abroad. ResultsThe management of asymptomatic carotid artery stenosis is shifting from reliance on the degree of stenosis alone to multidimensional assessment integrating clinical characteristics, plaque vulnerability, hemodynamic parameters and biomarkers. Best medical treatment is the cornerstone of treatment for all patients and should be continuously optimized through antiplatelet therapy, stepwise lipid-lowering therapy, risk factor control and lifestyle intervention. In patients with high-risk features for stroke or sufficiently long life expectancy and acceptable perioperative risk, carotid revascularization may be considered based on best medical treatment. At present, there are three main methods for carotid revascularization: carotid endarterectomy has the sufficient evidence in evidence-based medicine, transfemoral carotid artery stenting and transcarotid artery revascularization can be used to treat selected patients. Clinical management should follow a closed-loop pathway of assessment, treatment, and follow-up, incorporating multidisciplinary evaluation and shared decision-making. ConclusionsThe management of asymptomatic carotid artery stenosis should be based on best medical treatment, and individualized guided by multidimensional risk stratification. Future research should focus on developing risk-prediction and procedural decision-making tools apply to Chinese population and strengthening prospective studies and long-term follow-up.