b'Scientific Session Abstracts SUNDAY APRIL 21, 2024 29: TRANSCAROTID ARTERY REVASCULARIZATION VERSUS CAROTID ENDARTERECTOMY AMONG STANDARD RISK PATIENTS : MID AND LONG-TERM OUTCOMESDaniel Willie-Permor MD MPH , Sabrina Strauss, BA, Nadin Elsayed MD, Mahmoud B. Malas MD, MHS, RPVI, FACS. Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), Department of Surgery, University of California San Diego (UCSD), La Jolla, CaliforniaObjectives: Transcarotid artery revascularization (TCAR) is widely accepted as minimally invasive procedure for carotid revascularization in surgically high-risk patients. The Centers for Medicare and Medicaid Services (CMS) recently approved TCAR in standard-risk (SR) patients. Prior studies in high-risk (HR) patients, showed comparable stroke or death rates between TCAR vs CEA and lower stroke rates compared to transfemoral carotid artery stenting (TFCAS). However, data regarding the mid-term outcomes of TCAR among SR patients is lacking. The aim of this study was to evaluate mid-term outcomes of TCAR vs CEA in SR patients using an updated real-world analysis.Methods: We included 65,009 standard risk patients, 94.75% of whom underwent CEA and 5.25% of whom underwent TCAR between using the VQI-VISION data. Standard Risk was defined using the CMS anatomical and clinical criteria. The primary outcomes were 3-year survival post- procedure, assessed using Kaplan-Meier survival analysis and 3-year Hazard of mortality.Secondary outcomes included 30-day mortality, post-op stroke , and post-op myocardial infarction (MI).Kaplan-Meier survival curves were constructed to estimate survival probabilities , and the log-rank test was used to compare survival between the TCAR and CEA cohorts. Hazard ratios (HRs) and 95% confidence intervals (CIs) for 3-year mortality were estimated using a multivariable Cox proportional hazards model, adjusting for confounders, including those identified in the literature as affecting survival outcomes. The Cox model was verified for proportional hazards assumptions, and Schoenfeld residuals were used to test for violations.Results: Crude 30 day mortality rate was 0.47% in the CEA group vs 0.41% in the TCAR group(p=0.63). 30-day mortality/stroke rate was 1.86% in CEA vs 1.96% in TCAR(p=0.68). TCAR was associated with lower risk of MI (OR=0.46,95%CI:0.23-0.9,P=0.002). (Fig 1). There was no difference in 1- year survival(97.5% vs 97.1%, log-rank p=0.21) and 3-year survival(94.7% vs 94.5%, log-rank p=0.24) in KM survival analysis.(Fig 2). After adjusting for relevant confounders, the 1-year,2- year and 3-year risks of mortality were not different between both groups( aHR 1.18, p=0.20; aHR 1.22, p=0.08 and aHR 1.15,p=0.2; aHR, respectively).Conclusion: Using a large multi-institutional data in standard risk patients, we found lower risk of postoperative MI but no differences in mortality, mortality/stroke and 1-, 2- and 3-year survival. TCAR can be used safely in standard risk patients with comparable short and mid-term compared to CEA.76SOUTHERN CALIFORNIA VASCULAR SURGICAL SOCIETY'