Stop-Short Technique Doubles Carotid Dissection Risk During TCAR

Transcarotid artery revascularization has become a standard clinical alternative to carotid endarterectomy and transfemoral carotid artery stenting for patients at high surgical risk [1, 2]. By utilizing direct carotid access and dynamic flow reversal (a neuroprotective method that temporarily reverses blood flow to divert embolic debris away from the brain), this approach minimizes the embolic risks associated with navigating the aortic arch [3]. Despite these advantages, the procedure introduces specific technical challenges, including the risk of intraoperative common carotid artery dissection during arterial access or sheath insertion [4]. These vascular injuries are clinically significant because they frequently necessitate emergency surgical conversion or complex endovascular rescue and are associated with longer procedure times and increased contrast use [5, 4]. A recent registry analysis now offers precise data on the procedural techniques and patient characteristics that contribute to these intraoperative complications, providing vascular surgeons with actionable strategies to improve safety.