Transcarotid Artery Revascularization (TCAR)
What Is a TCAR Procedure?
The brain relies on a continuous oxygen supply primarily delivered by the carotid arteries. These arteries run from the aorta (the body’s main artery) up both sides of the neck, where their pulses can be felt alongside the trachea or windpipe and into the brain. Carotid artery disease occurs when cholesterol-laden plaque narrows one of these carotid arteries.
Plaque is a sticky substance made up of cholesterol, fat, blood cells, calcium and other substances found in the blood. A large piece of plaque can slow down blood flow to the brain. A ruptured piece of plaque may result in a blood clot, which can travel to the brain and lead to a transient ischemic attack (also known as ministroke) or a full stroke.
Carotid artery disease often remains asymptomatic until it significantly narrows or obstructs a carotid artery. A ministroke can serve as an initial warning sign. Unlike a full-blown stroke, a transient ischemic attack causes temporary symptoms that resolve within 24 hours and may include one or a combination of the following symptoms:
- Weakness or numbness on one side of the face, arms or legs
- Difficulty moving an arm or leg
- Trouble speaking or understanding speech
- Sudden vision changes
- Dizziness
A ministroke acts as an indicator that a more severe stroke may be on the way.
In some cases, a stroke itself serves as the first symptom of carotid artery disease. Stroke symptoms are the same as those of a ministroke but can lead to lasting damage, including paralysis, vision or speech impairments and even death.
Treatment options for carotid artery disease include medications, smoking cessation, sugar control and artery-opening surgical procedures. Medications involve taking aspirin or other antiplatelet agents, cholesterol-lowering statins and additional medications to lower blood pressure.
Carotid endarterectomy and angioplasty with stenting are the two artery-opening procedures used to remove the narrowing in the arteries. In a carotid endarterectomy, a surgeon opens the clogged carotid artery and removes cholesterol-filled plaque. An angioplasty with stenting involves a catheter insertion to flatten the plaque using a tiny balloon and a wire mesh stent to keep the artery open after balloon removal.
However, for older patients and those with other medical conditions along with carotid artery disease who are at risk for open surgery, TCAR is a newer and safer way of performing angioplasty with a stent.
Transcarotid artery revascularization, or TCAR, allows surgeons to treat carotid artery disease while preventing a patient’s risk for future strokes. TCAR is a unique hybrid procedure as it temporarily reverses blood flow from the artery away from the brain, so any bits of plaque that may break off are diverted away to prevent stroke during the repair. Other arteries in the body will supply sufficient blood to the brain during the procedure.
How Long Does a TCAR Procedure Take?
During a TCAR procedure, surgeons will make a small incision at the base of the patient’s neck, just above the collar bone, enabling surgeons to access the common carotid artery. A soft, flexible tube is inserted directly into the patient’s carotid artery through this incision. The TCAR procedure uses a specialized system that temporarily reverses blood flow to prevent loose plaque from reaching the brain, reducing the risk of stroke. Any captured material is filtered outside the body, and the filtered blood is then returned through a second tube in the patient’s upper leg. A carotid stent is then placed to stabilize the plaque in the carotid arteries, and blood flow resumes its normal direction after successful placement. Generally, the mean procedure time for a TCAR surgery, from incision to closure, is 75 minutes or less.
TCAR vs. Carotid Endarterectomy
TCAR surgery is an innovative carotid stenting technique that employs a flow-reversal neuroprotection approach that significantly reduces the risk of developing blood clots, which can block an artery during the procedure. It has similar risks to other carotid artery blockage treatments like carotid endarterectomy. Additionally, TCAR offers various benefits, including reduced risk of myocardial infarction (“heart attack”), cranial nerve injuries and shorter operative times. Vascular surgeons in the United States perform TCAR for high-risk patients and those with other complications.
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