Transcarotid Artery Revascularization (TCAR)
Introduction
Transcarotid Artery Revascularization (TCAR) is a novel, minimally invasive, hybrid procedure employed for the treatment of carotid artery disease and helps prevent prospective strokes.
Carotid artery disease, also known as carotid artery stenosis, occurs due to the deposition of plaque or fatty substances inside the walls of your carotid (neck) arteries. These arteries supply oxygen-rich blood from the heart to your brain. Due to plaque accumulation, the arteries become narrower or even completely blocked. This reduces blood flow to your brain and creates oxygen deficiency, increasing your risk of having a stroke.
Indications
Transcarotid artery revascularization is recommended for individuals with carotid artery stenosis who are considered high-risk for traditional carotid endarterectomy (CEA) or carotid angioplasty and stenting (CAS) procedures. CEA and CAS are regarded as the gold standard for the treatment of carotid artery stenosis. However, a possible complication of both these procedures employed for the prevention of stroke is ironically the likelihood of a stroke occurring during the procedure itself. Studies have indicated a higher likelihood of stroke at the time of traditional stenting as compared to surgery.
TCAR is an advanced technique to deliver a stent into a blocked carotid artery. It utilizes a unique transcarotid neuro-protection system (NPS) that is designed to minimize the chances of a stroke at the time of stent insertion. It allows your surgeon to directly access the common carotid artery at the neck and temporarily direct the blood flow away from the brain to prevent dangerous plaques from reaching the brain and causing a stroke during the procedure.
Preparation
In general, preoperative preparation for transcarotid artery revascularization will involve the following:
- A thorough history and physical examination
- Routine blood work and imaging
- Refraining from blood thinners, aspirin, or NSAIDs
- Informing your doctor of any allergies to medications, anesthesia, or latex
- Refraining from solids or liquids at least 8 hours prior to surgery
- Arranging for someone to drive you home following surgery
- Signing a consent form after the risks and benefits of the surgery have been explained
Procedure
The minimally invasive TCAR procedure is performed in a hospital setting under local or general anesthesia and involves the following:
- Your surgeon makes a small incision at the neckline just above the clavicle.
- A tube is placed directly into your carotid artery and connected to a TCAR system that temporarily reverses the blood flow to prevent loose debris from reaching the brain.
- Your blood will flow through the TCAR system and any debris will be captured in a filter outside the body.
- The filtered blood is then returned through a second tube in the thigh/groin area.
- A carotid stent is then implanted into the carotid artery to stabilize the plaque and help prevent strokes.
- After successful stent placement, blood flow reversal is turned off and the blood flow resumes in its normal direction.
Postoperative Care
In general, postoperative care and recovery will involve the following:
- Medications to prevent infection, blood clots, and manage pain
- Instructions on surgical site care and bathing
- Avoiding strenuous activities or lifting heavy weights for a specified period
- Refraining from smoking as it increases the risk of blood clots and hinders healing
- Eating an iron-rich and high-fiber diet that is low in fats, salt, and cholesterol
- Maintaining a healthy body weight with regular exercise and walking
Benefits
Some of the advantages of the transcarotid artery revascularization procedure over traditional carotid endarterectomy include:
- Smaller incision
- Less pain
- Quicker recovery
- Shorter hospital stay
- Reduced stroke risk
- Minimal scarring
Risks and Complications
Transcarotid artery revascularization is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Infection
- Bleeding
- Bruising/swelling
- Blood clots or deep vein thrombosis
- Injury to nerves or vessels
- Persistent pain
- Stroke
- Heart attack
Summary
Transcarotid artery revascularization (TCAR) is an innovative procedure to treat carotid artery disease that lessens the risk of stroke associated with other standard procedures such as carotid endarterectomy. The minimally invasive TCAR is a safe and advanced procedure that reduces the chance of a stroke during the operation or in the future. By following your doctor’s post-surgery recommendations, you can return to your daily routines without functional limitations to lead a normal life.
