TransCarotid Artery Revascularization (TCAR)

Each year, 15 million people suffer strokes worldwide. This silent killer is most often caused by blocked arteries and is a brain condition that comes with few warning signs. A stroke is a debilitating and life-threatening disease that causes over five million deaths annually, leaving another five million permanently disabled. Given their prevalence, strokes are the fifth leading cause of death in the United States.

Understanding Strokes

A stroke is a severe and life-threatening medical event. When a blood vessel in the body becomes blocked or bursts, the disruption prevents oxygen-rich blood from reaching the brain. If deprived of oxygen for even a short time, parts of the brain, which control all of your bodily functions, can die or become irreparably damaged. Once damaged, the brain can lose control of certain muscles and organs. In some instances, patients who suffer a stroke can lose the ability to speak and see and are at a higher risk of death.

The carotid artery is a critical pathway for blood to flow to the brain. When that pipeline is blocked, seconds count. A TCAR procedure can save your life.

What Is a TransCarotid Artery Revascularization?

TransCarotid Artery Revascularization (TCAR) is a safe and non-invasive approach to clear blockages or open narrowed carotid arteries. The carotid artery is the primary mechanism for the body to send oxygen-rich blood to the brain. When too much cholesterol is in the blood, our arteries can become blocked with plaque that collects on the artery’s walls. The plaque can rupture and cause a dangerous blood clot or narrow the artery until it is blocked. When the artery is blocked, the condition becomes life-threatening.

During the TCAR procedure, a small incision in the neck allows the surgeon to reach the carotid artery, which is a large pipeline that carries blood to the brain. When that pipeline becomes blocked, a stroke occurs. 

During TCAR, your surgeon will:

  • Make a small incision in the neck just above the collarbone
  • Carefully puncture the carotid artery
  • Insert a short hollow tube into the artery to protect the brain from dangerous debris
  • Reverse the blood flow in the artery (blood still reaches the brain via other arteries), directing it to your leg, where we can catch and remove any loose plaque before it causes a problem
  • Place a stent (an expandable mesh tube) or a surgical balloon to widen the artery
  • Close the incision

The entire procedure usually takes less than an hour. You can even choose to stay awake during the TCAR surgery while still benefiting from pain-relieving medications. 

Most patients go home the day after their TCAR. The surgery can be a lifesaver and is proven to effectively reduce the risk of future strokes.

TCAR Recovery

As a general rule, TCAR patients are kept in the hospital overnight for observation and most people return home the next day.
Follow your doctor’s instructions during the recovery period, which will likely include recommendations to rest for a week or so before resuming normal activities. Your doctor may also put you on medications to thin the blood and prevent future blood clots.

As a follow-up, your surgeon may also order a carotid ultrasound to check on your recovery process and monitor how the blood flows through the artery after the procedure.

TCAR Eligibility

For patients who smoke, have diabetes, high blood pressure, struggle with obesity, or have vascular disease in other parts of the body, traditional open surgery (carotid endarterectomy) may be too risky for doctors to perform.

In these instances, TCAR is often the best and safest solution. If you’ve been diagnosed with carotid artery disease but have a higher risk of complications with traditional open surgery, TCAR may be your best option.

Patients may also be eligible for TCAR if they are over 75 years old and have the following:

  • Carotid artery stenosis
  • Congestive heart failure
  • Experienced a heart attack in the past six weeks
  • History of neck or head surgery or irradiation treatment for cancer
  • Problems with your voice box (larynx) or neck
  • Severe pulmonary disease
  • Unstable angina

Why Is TCAR Better for Patients?

The TCAR procedure is safer than traditional open surgery because it reduces the chances of complications. This less-invasive surgery can restore blood flow to the brain without increasing the chances that you will experience infection or nerve injury from surgery.

TCAR also reduces the risk of heart attacks and strokes. In over 10,000 carefully performed and evaluated TCAR procedures, the evidence was compelling and showed that TCAR was a less invasive and more effective procedure than traditional surgery.

The Society of Vascular Surgeons, Centers for Medicare and Medicaid Services (CMS), and the U.S. Food and Drug Administration (FDA) investigated these procedures and determined the procedure is both safe and effective at preventing strokes.

TCAR vs. Carotid Endarterectomy

Medicine is constantly innovating and the TCAR procedure is another example of how surgeons have adopted new techniques to advance and improve upon life-saving procedures.
For many years, the traditional way to clear a blocked carotid artery was with a procedure called carotid endarterectomy (CEA). With the introduction of TCAR, many doctors are making the shift away from CEAs to TCAR and seeing beneficial results among patients.

Endovascular Today published the results of a study that shows the TCAR procedure is a less-invasive way to clear a blocked carotid artery than carotid endarterectomy. While TCAR is a more expensive procedure, it does lower the risk of surgical complications.

When comparing the TCAR procedure to the traditional CEA, studies found that TCAR offered:

  • 59% reduced risk of post-surgery myocardial infarction (heart attack)
  • 87% reduced risk of cranial nerve injury during the procedure
  • 35% lower odds of an in-hospital stroke
  • 26% less chance of more extended hospital stays past the standard one day

TCAR for Stroke Protection

Any time a patient suffers from carotid artery disease, the first and most important step in treatment involves clearing the plaque blockage.

In many cases, carotid artery disease is a severe condition and can cause a life-threatening stroke. Any surgical repair to this area of the body is delicate and comes with its own set of risks.

The TCAR procedure is often the best option for patients struggling with multiple health conditions who have a high risk of stroke and can be life-saving in many cases. However, every patient is different, so your surgeon will determine the best treatment plan based on your unique needs.