Carotid artery stenosis is a serious vascular condition that involves the narrowing of the carotid arteries, which supply oxygen-rich blood to the brain. This narrowing can increase the risk of stroke and impact quality of life. People with carotid artery stenosis often have other related conditions, such as peripheral artery disease (PAD), which affects the blood vessels in the legs and can increase cardiovascular risks. When carotid stenosis becomes severe, specialized treatments are needed to restore blood flow and prevent serious complications.
What is TCAR?
Traditional treatments for carotid stenosis include carotid endarterectomy (CEA), which requires a surgical incision in the neck, and carotid artery stenting (CAS), which accesses the carotid arteries through the groin. While effective, these procedures carry notable risks, including distal embolization. This occurs when a blood clot or other particle dislodges during the procedure and travels to smaller blood vessels, potentially blocking blood flow to the brain and causing a stroke.
Transcarotid artery revascularization (TCAR) is a minimally invasive procedure designed to treat carotid artery stenosis while minimizing stroke risk during treatment. This DROP HYBRID procedure provides patients with a safer alternative to traditional carotid interventions, especially for those considered high-risk for conventional surgery.
Unlike traditional carotid stenting that approaches through the groin, the TCAR procedure uses a small incision at the base of the neck to directly access the carotid artery. This direct approach dramatically reduces the distance that interventional devices must travel through the arterial system, decreasing the chance of dislodging plaque and causing stroke during the procedure.
Empire Vein & Vascular Specialists is the number one provider of TCAR in California with the most experience. As Dr. Trevor DerDerian explains, “We are seeing a revolution in the treatment of carotid artery occlusive disease unfold right before our eyes in a field that has seen little progressive change in the past several decades.”
What distinguishes the TCAR procedure is its unique neuroprotection system. During the procedure, blood flow in the treated carotid artery is temporarily reversed away from the brain, preventing any debris that might be dislodged during the stenting process from traveling to the brain and causing a stroke. This reversed blood is filtered through an external system that captures potentially harmful particles before returning the filtered blood to the body through a vein in the leg.
How does it work?
The TCAR procedure combines surgical principles with advanced endovascular techniques in a precise, step-by-step process. Here is an overview of the TCAR procedure steps:
Initial preparation
The procedure begins with the patient under local anesthesia and sedation, ensuring that the patient is comfortable.
Small neck incision
The vascular surgeon makes a small incision at the base of the neck to expose the common carotid artery.
Establishment of the flow reversal system
A specialized sheath is placed directly into the carotid artery and connected to the TCAR flow reversal system. Another small access point is created in the femoral vein in the groin area.
Blood flow reversal
When activated, the system creates a pressure gradient that temporarily reverses blood flow away from the brain. Instead, blood flows backward through the carotid artery, through the external filter system, and returns to the body via the femoral vein.
Protection of the brain
This reversed flow prevents any plaque particles dislodged during the procedure from traveling to the brain, significantly reducing stroke risk.
Stent placement
With neuroprotection established, a balloon angioplasty may be performed to widen the narrowed artery, followed by placement of a stent to keep the artery open.
Restoration of normal blood flow
Once the stent is securely in place, the flow reversal system is deactivated, normal blood flow resumes, and the small incision is closed.
TCAR Recovery and follow-up
The entire procedure typically takes 60-90 minutes and requires only a short hospital stay of one to two days for most patients. Follow-up appointments are scheduled to monitor the patient’s progress and ensure proper healing.
Potential risks and complications
Like any medical procedure, TCAR carries some risks. Common complications include bleeding, stroke, or temporary nerve injury near the surgical site.
Who is a candidate for TCAR?
The TCAR procedure is particularly valuable for patients with carotid artery disease who:
- Have significant carotid artery stenosis
- Are considered high-risk for traditional carotid endarterectomy due to:
- Advanced age (75 and above)
- Previous neck surgery or radiation
- Anatomical challenges that make surgery difficult
- Multiple medical comorbidities like heart disease, lung disease, or kidney problems
- Have restenosis (recurrent narrowing) after previous carotid interventions
- Present with difficult-to-access carotid lesions
- Prefer a less invasive approach with a faster recovery time
TCAR candidates undergo a comprehensive evaluation, including detailed medical history, physical examination, and specialized imaging like carotid duplex ultrasound, CT angiography, or MR angiography.
Benefits of TCAR for artery health
The TCAR procedure offers numerous advantages over traditional carotid stenosis treatments:
- Reduced stroke risk: Significantly lowers the risk of procedure-related stroke compared to traditional carotid stenting.
- Minimally invasive: Requires only a small neck incision rather than the larger surgical exposure needed for carotid endarterectomy, resulting in:
- Less tissue trauma
- Reduced risk of nerve injury
- Minimal scarring
- Less postoperative pain
- Shorter recovery time: Most patients return to normal activities within a week, compared to several weeks for traditional carotid surgery.
- Efficient procedure: The TCAR procedure typically takes less than half the time of carotid endarterectomy.
- High success rate: Clinical data show excellent technical success rates and low rates of restenosis.
- Applicable to high-risk patients: Provides a good treatment option for patients who are not ideal candidates for open surgery.
When to consult a doctor
You should seek evaluation by a vascular specialist if you experience any of these warning signs that might indicate carotid artery disease:
- Temporary weakness, numbness, or paralysis on one side of the body
- Sudden, severe headache with no known cause
- Difficulty speaking or understanding speech
- Visual disturbances or temporary vision loss in one eye
- Dizziness, confusion, or problems with balance and coordination
- Unexplained falls or fainting episodes
Additionally, people with the following risk factors should consider proactive screening for carotid artery disease:
- Age above 65 years
- High blood pressure
- Smoking history
- Diabetes
- High cholesterol
- Coronary artery disease
- Previous stroke or mini-stroke (TIA)
- Family history of stroke or carotid disease
Early detection and intervention for carotid stenosis are crucial for preventing stroke. At Empire Vein & Vascular Specialists, our board-certified specialists provide expert diagnosis and advanced treatment options, including TCAR, to help restore proper blood flow and reduce stroke risk. We develop customized treatment plans tailored to each patient’s needs. Our team is focused on making high-quality vascular care accessible, and we accept most insurance plans.
Our commitment to patient care and clear communication is reflected in the experiences of those we’ve treated. As Denise Meyer, one of our patients, shared: “Very thorough. Everything was explained to me so I could understand. Great people that work there.“
If you’re concerned about your vascular health or have been diagnosed with carotid artery stenosis, contact Empire Vein & Vascular Specialists at 1.800.VARICOSE (1-800-827-4267) to schedule a free vein screening.