Todd Wood and Meghan Dermody, with the FDA-approved TCAR device.
Santo “Sam” Iacono loves life. And thanks to decades-long care at Penn Medicine Lancaster General Health and a steadfast commitment to healthy living, the 84-year-old is more active than many people half his age. This is impressive for any octogenarian, much less one who has undergone quadruple bypass surgery, valve replacement, and two carotid artery procedures to prevent stroke that were performed via a newer, minimally invasive procedure that reduces operative risks — at age 82.
Iacono was first diagnosed with carotid artery disease — one of the leading causes of stroke in the US — in 1997. He underwent a procedure called carotid endarterectomy to remove the plaque in the carotid artery on the right side of his neck. In 2018, Todd Wood, MD, chief of Cardiology at Lancaster General Hospital, discovered a blockage in Iacono’s left carotid artery. This time, due to his age and the severity of the blockage, he was a candidate for a more minimally invasive stenting procedure called TCAR, or TransCarotid Artery Revascularization.
Wood teamed up with Meghan Dermody, MD, chief of Vascular Surgery and medical director of the Interventional Vascular Unit at LGH, to perform the TCAR procedure. The advanced system temporarily reverses blood flow away from the brain while a stent is inserted to open the narrowed carotid artery. Reversing blood flow and filtering it outside the body prevents any fragments of plaque that may become loose during the procedure from entering the brain. The minimal dissection also decreases the risk of local nerve injury and makes recovery easier for many patients.
The LG Health Heart & Vascular Institute, which was the first in Lancaster County to offer TCAR, successfully operated on LG Health’s 100th TCAR patient in August. “We’re one of the only TCAR teams in the country to pair a vascular surgeon with an interventional cardiologist,” Dermody said. “We take kind of a tag-team approach. While I’m working on the carotid, he’s accessing the femoral vein. It cuts down on time, which is better for the patient.”
Recovery usually takes one week, as compared to three to four weeks with a traditional carotid endarterectomy. Iacono, one of the first to undergo TCAR at LG Health, was home the next day without missing a beat in his active life. “I’m a walking miracle,” he reported after his surgery, as he approached 10 minutes on his treadmill…not winded at all.