Major Breakthrough In Treatment Of Carotid Artery Disease

Have you been told carotid artery surgery or stenting is too risky for you?

A new, FDA-approved procedure to treat carotid artery disease dramatically reduces the risk of stroke during and after carotid angioplasty and stenting (CAS). TransCarotid Artery Revascularization, or TCAR, is minimally-invasive, results in less nerve damage, lower risk of infection and reduces the risk of both stroke and heart attack. 

When you’ve experienced bouts of dizziness, confusion or blurred vision, or passing loss of coordination, weakness or numbness, especially in one side of the body, you may have had a mini-stroke or a transient ischemic attack (TIA). Because 1 in 3 people experiencing a TIA will have a full-blown stroke within a year after the TIA, you need to get screened for carotid artery disease immediately.

You may also be screened when your physician hears an abnormal sound through a stethoscope placed on the neck, if you have risk factors such family history, high blood pressure, diabetes, obesity or tobacco use, or if you have peripheral artery disease or vascular disease somewhere else in your body.

The carotid arteries run along either side of the neck and can be felt just below the angle of the jaw. These arteries deliver the oxygen-rich blood necessary for brain function. 

Carotid artery disease, or carotid artery stenosis, occurs when the arteries are narrowed by atherosclerosis, a build up of plaque. When your arteries are narrowed by 70% or more, you are at risk of having a stroke. 

About one-third of strokes are caused by carotid artery disease, and 80% of all strokes are preventable. 

To prevent a life-altering stroke, carotid artery disease must be treated. Seeing a vascular surgeon ensures your treatment is determined by your test results, current health and medical history, as only a vascular surgeon can perform both surgical options or interventional options. 

For decades, carotid endarterectomy (CEA) has been the “gold standard” of treatment. During this 90-minute to 2-hour surgical intervention, Dr. Tanquilut, Dr. Pradhan or Dr. Alhalbouni use a plastic tube to reroute blood flow to ensure the brain continues to receive oxygen. The surgeon will make a 8-10 cm incision in your neck where the blockage has been located, then open the carotid artery. The plaque is removed from the artery and the artery repaired. The surgeon will then restore blood flow to the brain along its natural path. 

Some patients are not candidates for CEA due to previous neck surgeries, radiation to the neck, having a higher surgical risk or unusual physiology; these patients have been treated with transfemoral carotid angioplasty and stenting (CAS). 

However, transfemoral CAS is an inferior treatment option for carotid artery disease. The vascular surgeon inserts a catheter into the femoral or brachial artery, and guides it via x-ray through the aorta to the carotid artery. Contrast materials are injected through the catheter to determine the exact location and severity of blockage. A balloon is inflated, compressing the plaque against the artery wall, and then a stent is placed to hold the newly widened artery open. 

Transfemoral CAS has an associated 4% risk of stroke, compared to surgery which has just a 1% risk of stroke.

Now, with the recent invention of TCAR, the high risk of heart attack and stroke during and after CAS has been drastically reduced, with excellent clinical data to support results. 

In a TCAR procedure, your Vascular Specialists surgeon will make a small incision just above the clavicle. A puncture is made into the carotid artery and a small tube is placed inside the artery, which is connected to the transcarotid neuro-protection system (NPS). The NPS temporarily directs blood flow away from the brain and captures plaque debris that dislodges from the artery. This dangerous debris is diverted away from the brain, preventing a stroke from happening. The blood is then filtered and returned to the femoral vein through a second tube placed in the groin. While the brain is protected during this temporary flow reversal, a stent is placed in the carotid artery to stabilize the plaque and help prevent against future stroke. The blood flow is then returned to normal and the NPS is removed.

You can be treated using a local anesthesia. Any disease in the aorta, aortic arch and the origin of the cartoid arteries is entirely avoided and the femoral artery is left untouched. The procedure takes approximately 40 to 80 minutes.  

You will recover more quickly and there is less risk for nerve damage, heart attack, bleeding and stroke.

TCAR has been clinically proven as a less-invasive alternative to CEA. Over 10,000 TCAR procedures have been performed around the globe since its introduction in 2016.

The TCAR procedure requires the training, experience and skills of a vascular surgeon. Your Vascular Specialist surgeon are the only fellowship-trained specialists with the skills and ability to solely perform open surgeries, minimally-invasive endovascular (stenting) procedures and complicated hybrid procedures such as TCAR. Because of these comprehensive skills, your Vascular Specialist surgeon will provide unbiased recommendations and treatment,  based on your individual needs.


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