Percutaneous Transluminal Carotid Artery Stent Placement

Transcarotid Artery Revascularization (TCAR)

TransCarotid Artery Revascularization (TCAR) is a cutting-edge, minimally invasive procedure used to treat carotid artery disease—a major contributor to stroke risk. This treatment has become a game-changer for patients at high risk, offering a safer, quicker option than traditional surgeries.

What Is Carotid Artery Disease?

The carotid arteries are essential blood vessels running along both sides of your neck, carrying oxygen-rich blood to your brain. When plaque builds up inside these arteries, it can reduce blood flow—sometimes by as much as 95%. This creates a serious risk for strokes, which occur when the brain doesn't get enough oxygenated blood. Carotid artery disease usually doesn’t show symptoms until a stroke happens, but vascular doctors can spot blockages before it’s too late.

Traditional Treatments for Carotid Artery Disease

Historically, Carotid Endarterectomy (CEA) has been the standard treatment. This invasive surgery requires a long incision along the neck to access the artery and remove plaque. The artery is then patched, and blood flow is diverted. While effective, CEA has a lot of downsides, such as large scars, prolonged recovery, pain, and risks of complications, including stroke during the operation. It’s also not suitable for patients with underlying health issues that make major surgery risky.

A newer option, Transfemoral Carotid Artery Stenting (TFCAS), offers a less invasive approach. It uses access from the femoral artery in the thigh to insert a stent and clear the blockage. However, this method can still cause complications, including the risk of embolism (when debris is released into the bloodstream), and stroke rates during the procedure are higher than with CEA.

For mild cases, non-surgical treatments like medication, diet, and lifestyle changes can help, but they aren’t effective for severe cases.

How Does TCAR Work?

TransCarotid Artery Revascularization (TCAR) is an advanced, minimally invasive treatment that combines the benefits of previous techniques and adds a game-changing component: blood flow reversal.

In traditional surgery, the biggest risk has been that debris dislodged from the artery could travel to the brain. To avoid this, TCAR reverses the blood flow in the affected artery during surgery. This ensures that any debris stays in the artery and doesn’t make its way to the brain, where it could cause a stroke.
During the procedure, blood is drawn out of the artery, filtered, and sent back into the body via the femoral artery, keeping blood pressure steady. Other arteries continue to feed the brain, ensuring adequate oxygen flow.

TCAR surgery is performed through a small incision just above the collarbone. A sheath is inserted into the artery, allowing the surgeon to reverse blood flow, open the artery, and insert a stent to clear the blockage. The incision is stitched up afterward, with minimal scarring.

A thorough history and physical examination
Routine blood work and imaging
Refraining from blood thinners, aspirin, or NSAIDs
Informing your doctor of any allergies to medications, anesthesia, or latex
Refraining from solids or liquids at least 8 hours prior to surgery
Arranging for someone to drive you home following surgery
Signing a consent form after the risks and benefits of the surgery have been explained

Advantages of TCAR

TCAR has several key advantages over CEA and TFCAS:

Clinically Proven: This procedure is backed by strong research and proven to be effective.
Minimally Invasive: Smaller incisions mean less pain and faster recovery.
Direct Access to the Carotid Artery: No need for long incisions or navigating through other areas.
Shorter Operating Time: Less time on the table means less risk and quicker recovery.
Lowest Risk of Stroke: TCAR has the lowest stroke risk during the procedure.
Less Discomfort: With fewer cuts, there's less pain.
Faster Recovery: Most patients go home the next day and feel better sooner.
No Need to Navigate the Aortic Arch: Avoids complications from longer access points.

What to Expect

Not everyone is a candidate for TCAR—doctors consider a variety of factors like overall health and risk before recommending the procedure. If you're eligible, your doctor will explain how to prepare for the surgery.

Be sure to follow pre- and post-surgery instructions closely, especially regarding medications. It’s also important to stay hydrated leading up to the procedure—your doctor will provide specific instructions on when to stop drinking. If you have any concerns or questions, reach out to your physician before and after the procedure.

After the TCAR Procedure

Most patients are discharged the day after the procedure. While some discomfort is normal, it should be manageable with over-the-counter pain relievers. Follow the doctor's advice about caring for the incision site. If you experience unusual symptoms like severe headaches, dizziness, or anything else out of the ordinary, contact your doctor immediately.

Medications to prevent infection, blood clots, and manage pain
Instructions on surgical site care and bathing
Avoiding strenuous activities or lifting heavy weights for a specified period
Refraining from smoking as it increases the risk of blood clots and hinders healing
Eating an iron-rich and high-fiber diet that is low in fats, salt, and cholesterol
Maintaining a healthy body weight with regular exercise and walking

Benefits

Some of the advantages of the transcarotid artery revascularization procedure over traditional carotid endarterectomy include:

Risks and Complications

Transcarotid artery revascularization is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

Infection
Bleeding
Bruising/swelling
Blood clots or deep vein thrombosis
Injury to nerves or vessels
Persistent pain
Stroke
Heart attack

Schedule an Appointment Today

If you or a loved one may benefit from TCAR treatment, book an appointment with us today!

Summary

Transcarotid artery revascularization (TCAR) is an innovative procedure to treat carotid artery disease that lessens the risk of stroke associated with other standard procedures such as carotid endarterectomy. The minimally invasive TCAR is a safe and advanced procedure that reduces the chance of a stroke during the operation or in the future. By following your doctor’s post-surgery recommendations, you can return to your daily routines without functional limitations to lead a normal life.

Schedule an Appointment Today

If you or a loved one may benefit from TCAR treatment, book an appointment with us today!