[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.170.75.58. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Views 137
Citations 0
Comment & Response
February 5, 2020

Transcarotid Artery Revascularization With Flow Reversal—Reply

Author Affiliations
  • 1Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
JAMA Surg. Published online February 5, 2020. doi:10.1001/jamasurg.2019.5445

In Reply We appreciate the interest in and commentary on our published systematic review1 of management and timing of intervention in patients presenting with crescendo transient ischemic attacks (cTIA).1 We agree with Paraskevas that the results from prospective2,3 and retrospectives studies4-6 suggest that transcarotid artery revascularization (TCAR) may be a revolutionary and durable carotid option for patients with some types of symptomatic presentation, such as TIA. However, data supporting TCAR have excluded patients with more urgent presentations, such as cTIA. For example, in the pivotal Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER) trial,2 patients with unstable neurological symptoms, such as cTIA, were excluded. In the retrospective study by Kashyap et al6 and retrospective studies of the Vascular Quality Initiative database,4,5 it is not possible to ascertain whether and which patients presented with cTIA. Therefore, the safety of TCAR in patients with acute cerebral ischemia is not yet established; larger studies with more granular data are needed to confirm the safety of TCAR in this specific patient population.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×