TCAR (Carotid Revascularization)

The carotid artery supplies oxygenated blood to the head and neck. A buildup of fatty substances that collect and stick to the linings of your arteries, a process known as atherosclerosis, can narrow the carotid and cause vascular disease. You may have also heard the terms “plaque,” “blockage,” “lesion,” or “stenosis” to describe this condition. As the plaque build-up continues, the internal lining of your artery thickens, which causes the artery to narrow and limit blood flow to vital tissues and organs. The symptoms from these blockages depend on what artery is affected and the severity of the blockages.

Stroke

Over 15 million people every year suffer a stroke, with nearly six million dying and five million left with some form of permanent disability. Severe carotid artery disease leads to strokes when plaque fragments travel to the brain. In excess of 30% of these cases are the result of the disease, with over 400,000 new diagnoses of carotid artery disease made every year in the United States.

Symptoms

  • Weakness, numbness, tingling, or paralysis of the arm, leg, or face on one side of your body
  • Trouble swallowing
  • Loss of eyesight or blurry eyesight in one eye
  • Dizziness, confusion, fainting, or coma
  • Unexplained, slurred, or garbled speech

Diagnosis

Blockages can be found when your physician hears a sound through a stethoscope placed on the neck. The sound is caused by blood flowing past the blockage. Sometimes, patients are screened for carotid artery disease if the doctor knows the patient has vascular disease elsewhere in the body.

The following tests may be performed if carotid artery disease is suspected.

  • Carotid artery ultrasound: This test uses sound waves that produce an image of the carotid arteries on a TV screen and can be helpful in identifying narrowing in the carotid arteries. This test is painless and does not require the use of needles, dyes, or x-rays.
  • Angiography: An angiogram uses x-rays to take a picture of your carotid artery. In order for the x-ray to “see” your arteries, a dye is injected through a small tube (catheter) inserted into an artery in the groin or arm. This procedure will determine exactly where the narrowing is located and will help to guide further treatments.

If carotid disease is diagnosed during one of these tests, your doctor will discuss your treatment options with you.

Treatment options

Depending on the severity of your condition and the symptoms present, there are a range of treatment options available for carotid artery disease. In cases of moderate blockages, interventional procedures may not be necessary. Severe blockages, however, may necessitate a treatment with open surgery called “carotid endarterectomy.” Alternately, some situations may require an endovascular procedure where a stent is implanted to prevent future strokes by stabilizing the plaque.

Carotid endarterectomy

Carotid endarterectomy is a surgical procedure that removes plaque from the inside of your carotid artery in order to restore normal blood flow to your brain. A surgeon will make an incision on your neck, access the affected artery, open it, and remove the plaque buildup. The surgeon will then close the artery and incision using stitches.

Transfemoral carotid artery stenting

In this minimally invasive alternative procedure, a physician works through a tube inserted into the artery in the upper thigh. First, a small, umbrella-like filter is placed beyond the diseased area of the carotid artery to help limit fragments of plaque from traveling towards your brain during the procedure. The physician then inserts a slender, metal-mesh tube, called a stent, which expands inside your carotid artery to increase blood flow to the brain and stabilize the plaque.

A major complication with all interventional procedures is the possibility of a stroke during the procedure itself. Studies have consistently shown a higher risk of stroke during transfemoral stenting as compared to open surgery.

Transcarotid artery revascularization (TCAR)

For patients suffering from carotid artery disease who cannot undergo traditional open surgery, a less invasive, clinically proven alternative called TCAR is available. Performed through a small incision above your clavicle, a surgeon places a tube into your carotid artery and connects it to a system that temporarily directs blood flow away from your brain. This safeguard aims to prevent dangerous debris from reaching your brain during the procedure. Your blood will be diverted through this alternate system, with debris and materials captured in a filter outside the body. The filtered blood will then be returned to your body via a second tube in your upper thigh.

During the procedure, a carotid stent will be implanted to stabilize the plaque, which helps to prevent future strokes. After the stent is in place, the flow reversal system is turned off and normal blood flow resumes. To date, TCAR has demonstrated the lowest stroke rate in clinical studies.