b"Scientific Session Abstracts SUNDAY APRIL 21, 2024 32: COMPARATIVE OUTCOMES OF REVASCULARIZATION MODALITIES IN CAROTID RESTENOSIS POST- CAROTID ARTERY STENTINGPooria Nakhaei 1 , MD, MBA, Mohammed Hamouda 1 , MD,Marjan Moghaddam 1 , BS, Nadin Elsayed 1 , MD, Ahmed Abdelkarim 1 , MD, Mahmoud B. Malas 1 , MD, MHS*1 Department of Surgery, Division of Vascular & Endovascular Surgery, UC San Diego, San Diego, CAObjective: Restenosis following Carotid Artery Stenting (CAS) is a complicated clinical scenario where data is notably sparse. The study's principal aim is to compare the current perioperative outcomes of Transfemoral carotid artery stenting (TFCAS), Transcarotid Carotid artery Stenting (TCAR), and Carotid endarterectomy (CEA) in patients with prior stenting, thereby filling this gap in existing research.Methods: A retrospective analysis of the Vascular Quality Initiative (VQI) database spanning 2016 to 2023 was conducted on patients who had previously undergone CAS and subsequently received CEA, TFCAS, or TCAR due to restenosis. To account for potential confounders and baseline differences among the cohorts, multivariable logistic regression was employed. Main outcomes of the study included: The composition of Stroke/Death, Stroke/Death/Myocardial Infarction (MI), mortality rates at 30 days and one year, as well as the length of hospital stay (LOS) and cranial nerve injury (CNI).Results: The study encompassed 2,394 patients with a prior ipsilateral CAS, among which 508 (21.2%) underwent CEA, 1109 (46.3%) received TFCAS, and 777 (32.4%) were treated with TCAR (Table I). In the comparison of TCAR vs. CEA, multivariate logistic regression revealed significantly lower rates of Stroke/Death (OR 0.43,95%CI:0.20,0.92,P=0.031), Stroke/Death/MI (OR 0.45, 95% CI:0.21, 0.97,P=0.041), and CNI (OR 0.09, 95% CI:0.03, 0.30,P0.001) in the TCAR group. LOS was significantly shorter in TCAR and TFCAS compared to CEA (OR 0.48 & 0.50, 95%CI:0.36-0.64&0.35-0.73, respectively, P0.001 for both). In comparing TCAR with TFCAS,TCAR was associated with significantly reduced incidences of Stroke/Death(OR2.45,95%CI:1.14,5.30,P=0.022) and Stroke/Death/MI(OR2.08,95%CI:1.02,4.25,P=0.042). In contrast, TFCAS demonstrated shorter LOS (OR0.72,95%CI:0.56,0.94,P=0.014) as shown in Table II.Conclusion: Within this study, TCAR outperformed both TFCAS and CEA in terms of Stroke/Death and Stroke/Death/MI outcomes. TCAR had a reduced LOS compared to CEA, whereas patients undergoing TFCAS experienced short-er LOS than those treated with TCAR. Notably, the incidence of CNI was sub-stantially lower in the TCAR cohort, exceeding a tenfold increase in frequency with CEA. The 30-day and one-year survival rates did not significantly diverge 84SOUTHERN CALIFORNIA VASCULAR SURGICAL SOCIETY"