TransCarotid Artery Revascularization, or TCAR, is a medical procedure designed to address blockages within the carotid arteries. It offers a less invasive approach compared to traditional open surgery, aiming to restore proper blood flow to the brain. TCAR combines surgical access with endovascular techniques to treat carotid artery disease and reduce stroke risk. The procedure involves a small incision in the neck to access the artery directly, incorporating a temporary blood flow reversal system for enhanced safety. This technique is often considered for individuals who may face higher risks with other revascularization options.
Carotid Artery Disease Explained
Carotid artery disease develops when fatty deposits, known as plaque, accumulate inside the carotid arteries. These two major blood vessels, located on each side of the neck, deliver oxygen-rich blood to the brain and head. The buildup of this plaque, called atherosclerosis, causes the arteries to narrow and stiffen. This narrowing, or stenosis, can impede blood flow, potentially depriving parts of the brain of oxygen.
Carotid artery disease increases stroke risk. If plaque breaks away from the artery wall, or a blood clot forms and obstructs the vessel, it can travel to the brain and cause an ischemic stroke. In its early stages, this condition often presents no noticeable symptoms, making it a silent threat. As the disease progresses, signs such as sudden numbness or weakness on one side of the body, trouble speaking, or sudden vision changes may indicate a transient ischemic attack (TIA) or a stroke, necessitating immediate medical attention.
How the TCAR Procedure Works
The TCAR procedure begins with the patient receiving anesthesia. A small incision, typically one to one-and-a-half inches long, is made just above the collarbone in the neck, directly accessing the common carotid artery. Through this incision, a specialized sheath is inserted into the carotid artery. This sheath connects to an external system that temporarily reverses blood flow in the carotid artery, away from the brain.
This temporary flow reversal protects the brain by diverting any small pieces of plaque or debris that might break off during the procedure. The blood, along with any dislodged material, is filtered outside the body through this neuroprotection system. Filtered blood is then returned to the patient’s body through a separate tube inserted into a vein in the upper leg. Throughout this process, the brain continues to receive blood supply from other arteries.
Once the brain is protected, a wire is guided past the narrowed section of the carotid artery. A balloon may then be inflated to expand the artery, followed by the placement of a metallic stent. This stent is a small mesh tube that helps keep the artery open and stabilize the plaque, minimizing future blockages.
After successful stent placement, temporary blood flow reversal is discontinued, and normal blood flow to the brain resumes. The tubes are then removed, and the neck incision is closed. This combination of direct access and active brain protection distinguishes TCAR from other carotid revascularization methods.
Who is a Candidate for TCAR
TCAR is often considered for individuals with carotid artery disease who require intervention to reduce stroke risk. Patients at higher risk for complications from traditional open carotid endarterectomy surgery are primary candidates. High-risk factors include advanced age (typically 75 years or older) or significant co-existing medical conditions.
Medical professionals also evaluate severe heart conditions, such as congestive heart failure, unstable angina, or a recent heart attack within six weeks. Patients with chronic lung disease, a history of prior neck surgery, or those who have undergone radiation therapy to the neck may also be suitable candidates. TCAR may also be recommended for individuals with specific anatomical challenges, such as carotid blockages located high in the neck or under the jaw, or significant carotid artery stenosis.
After the TCAR Procedure
Following TCAR, most patients can expect a short hospital stay, typically overnight for observation. This period allows medical staff to monitor for immediate post-procedure concerns. Patients generally experience minimal discomfort at the neck incision site.
Recovery is quick, with many individuals mobilizing soon after the procedure. Patients are advised to take it easy for about a week, avoiding strenuous activities like heavy lifting for two weeks. To help prevent blood clots in the treated artery, medications like aspirin, other antiplatelet drugs, and statins are commonly prescribed. As part of follow-up care, a carotid duplex ultrasound may be performed to assess blood flow through the stent and monitor the artery’s condition.