Carotid Artery Disease (CAD) involves the buildup of fatty deposits, known as plaque, within the arteries in the neck that supply oxygenated blood to the brain. This condition, called atherosclerosis, causes a narrowing of the vessel, which doctors refer to as stenosis. If fragments of this unstable plaque break away, they can travel to the brain and cause a stroke. To mitigate this serious risk, a procedure may be recommended to clear the blockage and restore the artery’s inner diameter. One modern, less invasive option for treatment is TransCarotid Artery Revascularization, commonly known by the acronym TCAR.
Defining TransCarotid Artery Revascularization
TCAR is a procedure designed to stabilize the existing plaque and widen the narrowed section of the carotid artery using a wire mesh tube called a stent. Access is gained directly through a small incision made at the base of the neck, typically positioned just above the collarbone. This allows the surgeon direct access to the carotid artery. The direct neck access distinguishes it from other stenting methods that utilize the femoral artery in the groin. By restoring the correct vessel size, the procedure aims to improve blood flow and prevent plaque from causing a future stroke.
The Unique TCAR Procedure Steps
The procedure uses temporary blood flow reversal as a neuroprotection strategy to safeguard the brain. A specialized sheath is placed directly into the common carotid artery. This sheath connects to an external system that initiates flow reversal by drawing blood out of the artery, away from the brain. The rerouted blood is channeled to a vein in the patient’s groin for return to the circulatory system.
The external system continuously filters the blood to capture any fragments of plaque or debris loosened during the manipulation of the artery. With the flow reversal system providing protection, the surgeon proceeds with stenting. This involves using a balloon to gently open the narrowed vessel and then deploying the stent. The procedure is often performed under local anesthesia and mild sedation.
Once the stent is securely positioned and the artery is fully opened, the surgeon stops the flow reversal and removes the specialized equipment. Blood flow to the brain immediately resumes its normal, forward direction through the newly stabilized artery. The small incision in the neck is then closed with sutures. The intervention typically takes one to two hours.
Comparing TCAR to Traditional Treatments
TCAR is a modern alternative to Carotid Endarterectomy (CEA) and traditional transfemoral Carotid Artery Stenting (CAS). CEA is open surgery requiring a larger incision along the neck to surgically remove the plaque. This approach necessitates general anesthesia and carries a risk of injury to cranial nerves near the carotid artery.
TCAR is a shorter procedure, often lasting 30 minutes less than CEA, and is associated with a lower incidence of cranial nerve injury due to the smaller incision and less dissection. TCAR has demonstrated similar rates of perioperative stroke and death when compared to CEA. This makes TCAR a valuable option for individuals who may not be suitable candidates for a lengthy open operation.
Traditional CAS is a minimally invasive technique involving guiding a catheter from the femoral artery in the groin up to the carotid artery. The main concern with this route is navigating instruments through the arch of the aorta. This complex path can inadvertently dislodge plaque from the aorta itself, increasing the immediate stroke risk as debris travels to the brain.
The direct transcarotid access used in TCAR completely bypasses the aortic arch, eliminating the risk of plaque dislodgement from that area. Furthermore, the TCAR flow reversal system provides more comprehensive brain protection than the filter devices used in traditional CAS. These differences in access and neuroprotection make TCAR the preferred stenting method for patients at high risk for open surgery.
Recovery and Long-Term Outlook
Recovery following a TCAR procedure is rapid. The standard hospital stay is brief, often requiring only one overnight stay for observation before the patient is discharged. During this short stay, physicians monitor the patient’s blood pressure and check for neurological changes.
Patients manage pain from the small neck incision with simple medications. The quicker recovery allows individuals to return to their normal activities sooner than following traditional open surgery. Long-term management includes a prescribed regimen of antiplatelet medicines and statins to ensure the stent remains functional and prevent further plaque buildup.
The treated artery requires ongoing monitoring through regular follow-up appointments. This surveillance often involves a carotid duplex ultrasound, a non-invasive test that checks blood flow and confirms the stent is fully open. TCAR provides durable results and maintains stroke prevention rates comparable to those of traditional open surgery over several years.