TransCarotid Artery Revascularization (TCAR)


Vascular Specialists now offers a new, FDA-approved procedure to treat carotid artery disease. 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.

Each year, about 15 million people world-wide experience a stroke. About one-third of strokes are caused by carotid artery disease, but 80% of all strokes are preventable. 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 containing cholesterol, fat, calcium, proteins and waste. When the disease progresses to 70% or more narrowing, you are at an elevated risk of having a stroke. 

For decades, carotid endarterectomy (CEA) has been the “gold standard” of treatment but if you’ve have a previous neck surgery, radiation to the neck, or have a higher surgical risk or unusual physiology you are a not a candidate for CEA. In years past, you would have been treated with transfemoral carotid angioplasty and stenting (CAS). Transfemoral CAS is an inferior treatment option for carotid artery disease and has an associated 4% risk of stroke, compared to surgery which has just a 1% risk of stroke.

Now, with the 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 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, with 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. 

If you are not a candidate for CEA, you now have a significantly better choice with the TCAR procedure.

The TCAR procedure requires the training, experience and skills of a vascular surgeon. A vascular surgeon is the only fellowship-trained specialist who has 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 Specialists surgeon will provide unbiased recommendations and treatment,  based on the individual needs of your patient. 

When you have questions, reach out to Vascular Specialists. We will be happy to explain how TCAR works and why it may be the best choice for you.

  1. 035” extra support guidewire, dilator and Uber Flex™ arterial sheath designed in combination for atraumatic vessel entry. 
  2. Angled-tip Uber Flex™ arterial sheath maintains coaxial position in lumen for smooth interventional device delivery and optimized flow reversal. 
  3. Uber Flex™ arterial sheath includes outer stopper with suture grooves and hub eyelets for sheath stability. 
  4. Extended working channel for interventional device delivery enhances transcarotid ergonomics away from image intensifier. 
  5. Shorter length 57cm EN ROUTE Transcarotid Stent delivery system optimizes working area and reduces stored energy for precise stent deployment. 
  6. Dynamic flow controller modulates reverse flow rate and integrated, 200µ filter captures embolic debris. 
  7. Percutaneous Venous Return Sheath completes the circuit and returns filtered blood to the patient. 
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