Evidence map›Paper›PMID 42092469›Full record

ArticleJournal of vascular surgery2026

Utilization of the stop-short technique in transcarotid artery revascularization is associated with intraoperative common carotid artery dissection.

Y Andrew Wu, Roberto G Aru, Solomon Mulugeta, Morgan Colling, Chen Dun, Midori P White, Jamie Schwartz, Andres Carvajal, Christopher J Abularrage, Michael C Stoner and 3 more

Abstract read
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In one paragraph

Article in Journal of vascular surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Y Andrew WuDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD; Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Surgery, Albany Medical Center, Albany, NY.
Roberto G AruDepartment of Vascular Surgery, Thomas Jefferson University, Philadelphia, PA.
Solomon MulugetaSilk Road Medical, Inc., Sunnyvale, CA.
Morgan CollingDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD.
Chen DunDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD; Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Midori P WhiteDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD; Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Jamie SchwartzDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD; Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Andres CarvajalDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD.
Christopher J AbularrageDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD.
Michael C StonerDivision of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
Jesse A ColumboSection of Vascular Surgery, Heart and Vascular Center, Dartmouth Hitchcock Medical Center, Lebanon, NH.
Sumaira MacdonaldSilk Road Medical, Inc., Sunnyvale, CA.
Caitlin W HicksDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD; Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: chicks11@jhmi.edu.

Funding

CARDIOVASCULAR EPIDEMIOLOGY INSTITUTIONAL TRAININGT32HL007024 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI Elizabeth Selvin · 1985 to 2026
$17.5M
Research and Mentoring in the Clinical Epidemiology of Cardiovascular Disease and Type 2 DiabetesK24HL152440 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI SELVIN, ELIZABETH · 2020 to 2024
$612k
Comparative-Effectiveness of Procedures for Carotid RevascularizationK08HL165087 · NHLBI · DARTMOUTH-HITCHCOCK CLINIC · PI Jesse A Columbo · 2023 to 2026
$587k
NHLBI NIH HHS K08 HL165087NHLBI NIH HHS K24 HL152440NHLBI NIH HHS T32 HL007024
6 · The paper itself

Abstract

backgroundTranscarotid artery revascularization (TCAR) has gained widespread adoption for carotid revascularization since the US Food and Drug Administration approved it for use in 2015. Intraoperative common carotid artery (CCA) dissection during the procedure remains a feared complication. However, data describing CCA dissection incidence and ways to mitigate it remain limited. We analyzed a contemporary, manufacturer-maintained registry to determine the incidence, risk factors, management strategies, and clinical outcomes of CCA dissection during TCAR.

methodsWe retrospectively analyzed the Silk Road Medical registry, which included all TCAR procedures performed between January 2023 and January 2024. We identified cases of CCA dissection, recorded the procedural step during which they occurred, and reviewed management strategies and perioperative acute stroke events. We used multivariable logistic regression to identify patient and procedural characteristics associated with CCA dissection and compared procedural metrics between patients with vs without CCA dissection.

resultsOf 25,346 patients undergoing TCAR (median age, 74 years; 61.9 % male), 300 (1.18%) experienced a CCA dissection. CCA dissections occurred most commonly during arterial sheath insertion (61.7%), followed by micropuncture access (21.7%) and guidewire manipulation (12.0%). Surgeons managed dissections with additional stent deployment (41.0%), conversion to carotid endarterectomy (22.0%), or other open surgical repairs (6.7%). Acute stroke events occurred in 2.3% of patients with CCA dissection (7/300). After risk adjustment, factors associated with CCA dissection included age ≥85 years (vs <65 years; adjusted odd ratio [aOR], 1.82; 95% confidence interval [CI], 1.17-3.02), female sex (aOR, 1.65; 95% CI, 1.31-2.07), and use of the stop-short technique (ie, maintaining the stiff guidewire within the CCA during sheath insertion instead of advancing to the external carotid artery [aOR, 2.25; 95% CI, 1.70-3.02]). Patients with CCA dissection had longer procedure times, greater fluoroscopy exposure, higher contrast use, and more frequent use of two or more stents compared to patients without CCA dissection (all P < .001).

conclusionsTCAR demonstrates a favorable safety profile, with a low incidence of intraoperative CCA dissection. Use of the stop-short technique was associated with a two-fold increase in the risk of CCA dissection. Surgeons should engage the external carotid artery during sheath insertion whenever possible to minimize the risk of CCA dissection.

Indexed as

Carotid Artery, CommonCarotid Artery InjuriesEndovascular ProceduresAgedAged, 80 and overDissection, Blood VesselFemaleHumansIncidenceMaleMiddle AgedRegistriesRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsCommon carotid artery dissectionStop-short techniqueTCARTranscarotid artery revascularization

Identifiers

PMID42092469
PMCPMC13221965

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.