b'Scientific Session Abstracts SATURDAY APRIL 20, 2024 22: THE IMPACT OF CONCOMITANT PROXIMAL CAROTID INTERVENTIONS ON RE-VASCULARIZATION AND OUTCOMESChung-Fu Lin, MS 1 ; Sneha Thandra, BS 2 ; Casey Ho 2 ; Nadin Elsayed MD 2 ;Sina Zarrintan MD, MS, MPH 2 ; Mahmoud Malas, MD, MHS, RPVI, FACS 2 ;Ann C. Gaffey, MD, MS 21Georgetown University School of Medicine2 Center for Learning and Excellence in Vascular and Endovascular Surgery (CLEVER), Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego (UCSD), San Diego, CaliforniaObjective: Atherosclerotic stenosis at the carotid bifurcation and ipsilateral proximal common carotid artery (CCA) is an uncommon cerebrovascular condition. There has not been a standard approach for this multilevel condition. We aim to examine the postoperative outcome following ipsilateral proximal endovascular intervention with carotid endarterectomy (CEA+IPE),transfemoral carotid artery stenting (TFCAS+IPE), and transcarotid artery revascularization (TCAR+IPE).Methods: A retrospective review of patients undergoing concomitant proximal lesion intervention with CEA+IPE, TFCAS+IPE, and TCAR+IPE in the Vascular Quality Initiative database between 2016 and 2023 was performed. The primary outcome was in-hospital major adverse cardiac events (MACEs), including stroke, death, and MI. Secondary outcome was extended length of stay (eLOS). Logistic regression models were used for multivariate analyses, adjusting for potential confounders. Variable selected using stepwise regression and clinically relevant variables were in the final models.Results: Our study included 843 (61.6%) CEA+IPE, 297 (21.7%) TFCAS+IPE, and 228 (16.7%) TCAR+IPE. TCAR patients were more likely to have history of stroke, greater than 80% ipsilateral carotid stenosis, diabetes, CAD, and CKD compared to CEA+IPE and TFCAS+IPE. When compared to CEA+IPE, both TCAR+IPE and TFCAS+IPE exhibited no difference in combined stroke/death/MI (aOR=0.48, [95% CI:0.20-1.10], P=0.08), (aOR=1.08, [95% CI: 0.58-1.98], P=0.81), in stroke (aOR=1.07, [95% CI:0.42-2.72], P=0.9), (aOR=1.36, [95% CI:0.59-3.16], P=0.473), or in death (aOR=0.49, [95% CI:0.11,2.22], P=0.35), (aOR=0.78, [95% CI:0.25-2.43], P=0.67), respectively. However, there was a significant decrease eLOS (aOR=0.59, [95% CI: 0.43-0.82], P=0.002), (aOR=0.42, [95% CI: 0.31-0.59], P0.001) in TCAR+IPE and TFCAS+IPE compared to CEA+IPE. Furthermore, TCAR+IPE and TFCAS+IPE had similar combined stroke/death/MI (aOR=0.43, [95% CI: 0.17-1.10], P=0.078) and risk of eLOS (aOR=1.4, [95% CI: 0.91-2.19], P=0.12) (Table I).Conclusion: There is no significant difference observed in the risk of MACEs in CEA+IPE, TFCAS+IPE, and TCAR+IPE. However, endovascular techniques were associated with shorter hospital stay. Notably, a trend towards reduction in MACEs was observed in TCAR+IPE compared to CEA+IPE and TFCAS+IPE, suggesting a promising minimally invasive approach. Further research is needed to establish standard approach to this multilevel condition.66SOUTHERN CALIFORNIA VASCULAR SURGICAL SOCIETY'