A vial showing the emboli, blood clots, that were filtered from Donna Carr’s blood during a TCAR procedure.
The filter was littered with globular, pink bits. Small. Really small. But these tiny bits of tissue could have left Donna Carr debilitated for the rest of her life…if they didn’t kill her.
“I was knocking on heaven’s door, for goodness' sake!” she said of her ordeal last fall.
Instead, those emboli—blood clots—were filtered out of her blood hours after she showed up at the Penn Medicine Chester County Hospital emergency department with signs of a stroke. The hospital was more prepared to take care of a patient like Carr, thanks to investments in advanced operating rooms and the people trained in leading-edge stroke treatment.
A small window for treatment
In October 2024, when Carr had some pain and stiffness in her right hand, she thought it was just arthritis and took ibuprofen daily. That went on for a month, and then the situation escalated. “I woke up and got out of bed and had heaviness in my right leg,” Carr said. She went to an urgent care facility and was told she was likely having a stroke. Carr’s husband drove her straight to the hospital where a scan showed almost complete blockage of her carotid artery. She needed immediate treatment.
“Because it was symptomatic, there is a small window of opportunity,” said Daniel Lee, MD, a vascular surgeon who practices at the hospital and operated on Carr. “We felt the TCAR procedure would be the safest way for us to proceed in terms of preventing more strokes from happening in the future.”
TCAR, or transcarotid artery revascularization, is a minimally invasive procedure in which the blood flow around a blockage is reversed as a surgeon uses a balloon and stents to reopen the artery. Meanwhile, blood flows into the brain through other vessels while plaque and clots are diverted away and filtered out. The procedure has been in use at academic medical centers for more than a decade, but an expansion of surgical facilities and the upgraded training of some staff at Chester County Hospital meant Carr could be treated close to home in West Chester, and immediately.
An investment pays off
Donna Carr with Daniel Lee, MD after a follow-up appointment. Lee performed the surgery to place a stent in Lee’s carotid artery after she showed up at Chester County Hospital with stroke symptoms.
TCAR is made much easier by a hybrid operating room, which marries the qualifications of a standard operating room with the X-ray imaging and other tools needed for endovascular procedures.
“We know that we are in control of the imaging,” said Lee, “which allows us to pick up on millimeter discrepancies, an exquisite amount of detail.”
For Lee, cases like Carr’s justify Penn Medicine’s investment into a hybrid OR at Chester County Hospital, “100 percent, without a doubt.” He believes Carr could have had a worse outcome without the TCAR procedure. The clots that were filtered from her blood during the procedure might have gone to the brain and caused a stroke if a more traditional open surgery had been performed, Lee said.
The hybrid OR also uses a team cross-trained in both traditional surgical procedures and the catheter lab, which pares down the number of personnel needed for a procedure. The byproduct is nimbler scheduling, meaning patients can get the care they need faster.
Before the hospital had a hybrid OR and the cross-trained teams to staff it, it was a complex and layered process just to schedule a patient. “However, by adopting a hybrid approach, we have significantly streamlined this aspect of care delivery,” said Christopher Dearing, MSN, RN, BS, RRT, director of Heart & Vascular Services at CCH.
A virtuous cycle
Imaging shows Carr’s carotid before and after TCAR surgery at Chester County Hospital.
Having this hybrid capability unlocks a virtuous cycle: More advanced facilities attract more innovative care providers, who offer better services to patients, which prompts more investment in advancement. Lee is just one of those innovators attracted to Chester County Hospital.
“He doesn’t shy away from taking big cases like this. He’s like, ‘Bring it!” said the hospital’s Interim Chief Medical Officer, Davis Clark, DO. He noted there’s been more recent success in recruiting clinicians like Lee, who started seeing patients at the hospital two years ago, “because they see the capabilities of what they can do out here versus a conventional OR setting.”
The hybrid OR has helped spark an evolution at Chester County Hospital, where the ambitions of a big research hospital are moored in the values of a community hospital.
“We’re all of one mindset and one mission, which is to provide the cutting edge, to grow the department, and to become a place where everybody from the community can access our resources and not have to go into the city,” said Lauren Waronker, CRNP, the lead advanced practice provider in vascular surgery.
In Carr’s case, she was able to stay in a hospital she knows well. For the past decade, Carr has worked as a unit secretary in the hospital’s Labor and Delivery department, so when it became clear she could have the TCAR surgery at Chester County Hospital, it was an easy decision.
“I was like, ‘do I want my family going downtown [to visit me]?’” said Carr. "‘Heck no!'" She also lauded Lee: “He saved my life, what can I say? ... I can’t brag about him enough.”
Carr is doing well now, with only some light residual weakness in her hand. Follow-up ultrasounds show the stent placed by Lee in her carotid artery is keeping the vessel wide open and blood is flowing. It’s an outcome that easily could have been much worse. Instead, Carr is seizing on the chance to knock on a different type of door: retirement. “Oh absolutely! Carpe diem!”