Post-transcarotid artery revascularization duplex surveillance is probably costly and perhaps should be performed selectively, as it detected only 2 patients requiring potential re-intervention at an estimated hospital charge of $1,017,730 against a reimbursement of $272,345.
The overall rate of in-stent restenosis greater than 50% following TCAR was 7% over a mean follow-up of 30 months.
Freedom from greater than 50% in-stent restenosis declined over time, with rates of 94%, 90%, and 89% at 12, 24, and 36 months respectively.
Post-TCAR duplex surveillance generated substantial hospital charges that far exceeded reimbursement.
Applying Society for Vascular Surgery guidelines, routine post-TCAR surveillance detected only 2 patients who may have benefited from re-intervention.
The authors concluded that routine post-TCAR surveillance is probably costly and should perhaps be performed selectively.
This research suggests that routine ultrasound monitoring after a carotid artery stenting procedure called transcarotid artery revascularization (TCAR) may not be cost-effective when applied to all patients. In a study of 301 patients followed over an average of 2.5 years, researchers found that while 7% of patients developed significant narrowing of their stent (restenosis), only a small fraction — 2 out of 301 patients — had severe enough narrowing that they might have needed additional treatment under current medical guidelines, and these 2 patients also experienced strokes. The financial picture is striking: performing routine follow-up ultrasound scans on all patients generated an estimated $1,017,730 in hospital charges, but the actual reimbursement received was only about $272,345 — roughly one quarter of the charges. This means the healthcare system absorbed a large financial shortfall for a surveillance program that, based on current guidelines recommending medical management for most asymptomatic cases, identified only 2 patients who might have benefited from re-intervention. This research suggests that blanket routine surveillance after TCAR may impose significant financial costs on hospitals relative to the clinical benefit detected. The authors propose that post-TCAR surveillance might be better targeted — performed selectively based on individual patient risk factors — rather than applied uniformly to all patients. However, they caution that further research is needed before changing clinical practice, as the study is limited by its retrospective, single-institution design.
AbuRahma A, Cragon R, AbuRahma Z, Dees K, Fong S, Dargy N, et al.. (2026). Financial implications of post-transcarotid artery revascularization duplex surveillance.. Seminars in vascular surgery. https://doi.org/10.1053/j.semvascsurg.2026.06.008