TCAR

Carotid artery disease develops when cholesterol and other fatty substances collect in the arteries that send blood to the head and brain. This process, atherosclerosis, creates buildups (plaques) that narrow the arteries, reducing blood flow.

Atherosclerosis can develop slowly over time, until a carotid artery becomes blocked. But blood clots can also suddenly form, and plaque can break off and get stuck. At times, the brain still has enough blood, since two carotid arteries supply it. But sometimes critical blood flow is cut off, causing a stroke and destroying brain cells in minutes.

Learn more about carotid artery disease.

Conservative treatment, such as lifestyle changes and medications, can safely manage mild to moderate carotid artery disease. For more severe blockages, or if you’ve already had a stroke, you typically need minimally invasive stenting or open surgery (endarterectomy). We also offer a newer, safer hybrid procedure called TCAR.

What is transcarotid artery revascularization (TCAR)?

TCAR is a newer, specialized procedure that combines minimally invasive and open approaches for carotid artery blockages.

As a hybrid treatment, TCAR offers a less invasive approach that still maintains safeguards found in open surgery. It can provide an option for people at higher risk of plaque breaking off and traveling to the brain, causing a stroke.

Benefits of transcarotid artery revascularization (TCAR)

TCAR combines the advantages of endovascular intervention and open surgery in a safe, effective treatment for carotid artery disease:

• Open surgery to treat carotid artery disease requires a larger neck incision and a longer recovery.
• With traditional carotid angioplasty and stenting (CAS), surgeons start by going through the femoral artery in the groin. That access means the catheter must travel much farther through arteries that potentially contain plaque, including the aortic arch. TCAR starts at the carotid arteries, so plaque is less likely to break off and cause a stroke.
• The procedure uses a system that temporarily reverses the artery’s blood flow away from the brain. This step catches any plaque that breaks off and prevents it from traveling to the brain. The brain still receives enough blood and oxygen through the other artery.

The steps for TCAR include:

1. Your surgeon makes a small incision in the neck to access the carotid artery. The doctor clamps the artery below the blockage to temporarily stop the blood flow.
2. After making a small puncture in the artery, the doctor places a specialized sheath (thin, flexible tube) that connects to a blood flow reversal system. If plaque does break off during treatment, the system prevents it from traveling to the brain. The system also filters any debris from the blood and returns it through another sheath into a femoral (upper thigh) vein. The blood returns to the heart from there.
3. While blood flow is reversed, your surgeon inserts a catheter tipped with a tiny balloon into the sheath in the carotid artery.
4. Your doctor guides the catheter to the blockage. The balloon inflates and opens the artery for proper blood flow.
5. A stent (thin, metal-mesh tube) is placed inside the artery to hold it open.
6. Your surgeon removes the clamp from the artery, then takes out the catheter, sheath and other instruments. Blood flow resumes its normal path to the brain, and the doctor closes the incision in the neck.

After the procedure, you can expect a hospital stay of one or two nights, with some people needing recovery time in our intensive care unit (ICU). You receive pain medication as needed, and your care team monitors your vital signs and your brain function.

We provide instructions before you leave the hospital for at-home care. Your overall recovery time is about one to two weeks following the procedure. Your first follow-up appointment typically takes place about four to six weeks after the procedure.