Carotid artery stenosis raises stroke risk in many people, and that risk increases with age.
Fortunately, those who are not candidates for open surgery have a safe, highly effective option for treatment of carotid artery stenosis. Transcarotid artery revascularization (TCAR) offers a minimally invasive approach to treat carotid artery stenosis and decrease the risk of stroke.
What Is Transcarotid Artery Revascularization (TCAR)?
TCAR is a minimally invasive procedure that can clear blockages and open a narrowed carotid artery. The surgeon makes an incision over the common carotid artery to perform the repair.
During the TCAR procedure, the surgical team reverses blood flow in the area of the blockage. This reversal decreases the risk of stroke as your surgeon uses a surgical balloon and stents to reopen the narrowed artery. Blood still reaches your brain through other blood vessels.
TCAR Procedure Eligibility
TCAR is a good option for people who have a higher risk of complications from surgery due to age or other health issues. Your doctor will discuss whether you a good candidate for TCAR.
At Penn, many of our patients are eligible for TCAR. We often can offer TCAR to people who are at high risk for complications from surgery, have appropriate anatomy and have carotid artery stenosis:
- Greater than 50 percent with symptoms
- More than 70 percent without symptoms
You may also be a candidate for TCAR instead of carotid endarterectomy if you have:
- Age of 75 or older
- Congestive heart failure or unstable angina
- Heart attack (myocardial infarction) within the past six weeks
- History of head or neck surgery or irradiation
- Other problems with your larynx (voice box) or neck
- Restenosis (carotid stenosis that returns after surgery) or stenosis in both carotid arteries
- Uncontrolled diabetes or severe pulmonary (lung) disease
Transcarotid Artery Revascularization (TCAR): The Penn Medicine Difference
Penn is a national leader in the treatment of carotid artery stenosis and stroke prevention. When you choose TCAR at the Penn Vascular Surgery and Endovascular Therapy Program, you can rely on our:
- High level of experience: TCAR is only one of the options we offer to treat carotid artery stenosis and other carotid artery disease. We also offer traditional open surgery (carotid endarterectomy) and transfemoral carotid angioplasty and stenting. This array of options enables highly individualized treatment.
- Trusted experts: Doctors around the region refer people with challenging carotid artery disease and other vascular disease conditions to us. Penn vascular surgeons have a high level of expertise in successfully managing unique situations that other doctors don’t encounter often.
- Measurable outcomes: Penn is part of the Vascular Quality Initiative (VQI), an effort sponsored by the Society for Vascular Surgery. Participating in a voluntary registry to track our outcomes shows that we are committed to ensuring the best results possible. It also means we work to choose the safest and most effective treatments for you.
- New therapies: As an academic medical center, Penn provides the newest therapies for all types of vascular conditions, including carotid artery disease. Our involvement in clinical trials and translational research gives our patients access to new treatment options not available elsewhere.
The TCAR Procedure: What to Expect
You undergo TCAR in an operating room at the hospital. Your team includes a vascular surgeon, nurses, technicians and a vascular anesthesiologist. During the TCAR procedure:
- You receive anesthesia to keep you calm and comfortable. Your surgeon will tell you ahead of time if you’ll have moderate sedation and a local anesthetic or if general anesthesia (to put you to sleep) is a better choice for you.
- Your surgeon makes a small incision above your collarbone (clavicle) or a vertical incision over your common carotid artery.
- The surgeon inserts a tube into your carotid artery and connects it to an advanced system that temporarily reverses blood flow. By directing blood flow away from the brain, we can catch and remove any loose fragments of plaque before they cause a problem.
- The filtered blood returns to your body through a tube (catheter) inserted into a vein in your groin.
- The surgeon places a stent (a small wire mesh tube) in your carotid artery. The stent stays in place to hold open the carotid artery.
- Your surgeon removes the surgical tube, restores the direction of blood flow and closes the incision with stitches.
TCAR recovery
Most people go home the day after a TCAR procedure. You should expect to take it easy for at least a week before returning to your usual activities. Your doctor will likely recommend taking aspirin and another drug to prevent blood clots, as well as a statin. These medicines help reduce long-term complications like stroke and heart attack.
At some point after your TCAR recovery, your doctor will order a carotid duplex ultrasound to check for carotid artery stenosis or narrowing. This test uses sound waves to show how blood is flowing through the artery. You can have this test at a Penn vascular testing and diagnosis lab.
TCAR versus Carotid Angioplasty and Stenting
TCAR and transfemoral carotid angioplasty and stenting are both minimally invasive alternatives to carotid endarterectomy. The major difference between the two is that TCAR uses advanced technology to reverse blood flow away from your brain during the ballooning and stenting procedure. It can be a safer alternative to transfemoral carotid artery stenting.
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